Perioperative outcomes of robotic and laparoscopic adrenalectomy: A large international multicenter experience

Aim of the study: Laparoscopic adrenalectomy (LA) is the gold standard for the treatment of most of adrenal masses, although open approach is still the gold standard for large adrenal masses. Moreover, robotic adrenalectomy (RA) has increasingly been adopted, although evidence is still sparse. Aim of this study was to report and compare perioperative outcomes of patients treated with LA and RA in two academic tertiary referral centres. Materials and methods: Preoperative and perioperative data from patients undergoing both laparoscopic and robotic adrenalectomy performed at 2 Urology Units and 1 General Surgery Unit from March 2008 to February 2018 by six highly experienced laparoscopic and robotic surgeons were collected. LA was performed with a transperitoneal or a retroperitoneal approach according to surgeon preference while a transperitoneal approach was used in all cases of RA. Preoperative and perioperative features of patients treated with LA and RA were compared using Chi-square and Mann-Withney test as appropriate. Univariable and multivariable analyses were performed to identify predictors of postoperative complications within three months after surgery. Results: Overall, 477 patients were included. Preoperative and perioperative features are displayed in table 1, according to surgical approach. Preoperative characteristics (including gender, age, BMI, Charlson Comorbidity Index and history of previous abdominal surgery) were comparable among patients treated with LA and RA expect for the ASA score that was higher in the RA group (3 vs 2 in the RA and LA, respectively; p = 0.03). Median tumor size was 4 cm and 3 cm in the RA and in the LA group, respectively (p = 0.10). Median operative time was 110 minutes in both groups (p = 0.94) while median estimated blood loss was slightly inferior in the robotic group (80 vs 50 cc in the RA and LA, respectively; p < 0.001). Intraoperative complications occurred in 7 (6.3%) cases in the RA group and in 22 (6.0%) cases in the LA group (p = 0.89). Postoperative complication rate was comparable among the two groups with 13 (11.8%) and 35 (9.5%) complications reported in the RA and LA groups, respectively (p = 0.37). Median (IQR) hospital stay was 4 (3–4) days in both groups (p = 0.54). Malignant histology was found in 11.1% and in 12.8% of cases in the RA and in the LA group, respectively (p = 0.63). At multivariable analysis, increasing tumor size (OR 1.28; CI: 1.128–1.468; p = 0.001) was the only predictor of post-operative complications, while surgical approach was not (p = 0.896). Discussion: Robotic adrenalectomy is a safe procedure with similar perioperative outcomes compared to laparoscopic approach when performed in high volume centres by expert surgeon