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Robotic Posterior Retroperitoneal Adrenalectomy: Patient Selection and Long-Term Outcomes

  • Endocrine Tumors
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Recently, efficacy of laparoscopic posterior retroperitoneal adrenalectomy (PRA) for pheochromocytoma and malignancy has been questioned. Although robotic technique using wristed instruments may improve limitations of laparoscopic PRA, the worldwide experience with robotic PRA is limited. This study aimed to describe patient characteristics, surgical technique, and long-term outcomes of robotic PRA from a 12-year single-center experience.

Methods

This analysis was an institutional review board-approved retrospective study. In this study, PRA was performed robotically, with intraoperative ultrasound and indocyanine green imaging guidance. Long-term outcomes and predictors of operative time (OT) were assessed using descriptive and regression analyses. Using OT as a surrogate for difficulty of procedure, receiver operating characteristic curve analysis was performed to quantify anthropometric thresholds that would predict a more challenging procedure.

Results

Altogether, 112 robotic PRA procedures were performed. Three cases (3%) were converted to a lateral approach, and one case (1%) was converted to open surgery. The morbidity rate was 2%. Microscopic capsular disruption occurred for one patient. No patient experienced persistent disease or local recurrence from pheochromocytoma or malignant adrenal tumors during the follow-up period (median, 48 months). Operating time was independently predicted by perirenal fat thickness, with 18.5 mm as the critical threshold.

Conclusion

In this study, favorable PRA outcomes were achieved with careful patient selection and meticulous surgical technique that used robotic articulation guided by intraoperative imaging.

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Authors and Affiliations

  1. Department of Endocrine Surgery, Cleveland Clinic, Cleveland, OH, USA

    Mehmet Gokceimam MD, Serkan Akbulut MD, Ozgun Erten MD & Eren Berber MD, MBA

  2. Department of General Surgery, Cleveland Clinic Florida, Weston, FL, USA

    Bora Kahramangil MD

Authors
  1. Mehmet Gokceimam MD
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  2. Bora Kahramangil MD
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  3. Serkan Akbulut MD
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  4. Ozgun Erten MD
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  5. Eren Berber MD, MBA
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Corresponding author

Correspondence to Eren Berber MD, MBA.

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Disclosures

No financial support was received for this study. Unrelated to this study, Dr. Eren Berber has consulting agreements with Ethicon, Medtronic, Aesculap, and Integra. He has received honoraria for consulting work. The other authors have no conflicts of interest.

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Gokceimam, M., Kahramangil, B., Akbulut, S. et al. Robotic Posterior Retroperitoneal Adrenalectomy: Patient Selection and Long-Term Outcomes. Ann Surg Oncol 28, 7497–7505 (2021). https://doi.org/10.1245/s10434-021-10088-w

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  • DOI: https://doi.org/10.1245/s10434-021-10088-w

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