Minimally Invasive Adrenalectomy: Technical Aspects  of the Laparoscopic and the Robotic Approach

Abstract Background To compare the perioperative outcomes of transperitoneal laparoscopic (TLA), retroperitoneal laparoscopic (RLA), and robot-assisted transperitoneal laparoscopic (RATLA) adrenalectomy for adrenal tumors in our center. Methods Between April 2012 and February 2018, 241 minimally invasive adrenalectomies were performed. Cases were categorized based on the minimally invasive adrenalectomy technique. Demographic characteristics, perioperative information and pathological data were retrospectively collected and analyzed. Results This study included 37 TLA, 117 RLA, and 87 RATLA procedures. Any two groups had comparable age, ASA score, Charlson Comorbidity Index, and preoperative hemoglobin. The tumor size for RLA patients was 2.7 ± 1.1 cm, which was significantly smaller compared to patients who underwent TLA/RATLA (p = 0.000/0.000). Operative time was similar in any two groups, while estimated blood loss was lower for RATLA group (75.6 ± 95.6 ml) compared with the TLA group (131.1 ± 204.5 ml) (p = 0.041). Conversion to an open procedure occurred in only one (2.7%) patient in the TLA group for significant adhesion and hemorrhage. There were no significant differences between groups in terms of transfusion rate and complication rate. Length of stay was shorter for the RATLA group versus the TLA/RLA group (p = 0.000/0.029). In all groups, adrenocortical adenoma and pheochromocytoma were the most frequent histotypes. Conclusions Minimally invasive adrenalectomy is associated with expected excellent outcomes. In our study, the RATLA approach appears to provide the benefits of decreased estimated blood loss and length of stay. Robotic adrenalectomy appears to be a safe and effective alternative to conventional laparoscopic adrenalectomy.

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Technical Aspects of Minimally Invasive Direct Coronary Artery Bypass Surgery: Single-Center Experience

10.1055/s-0039-1678776 ◽

2019 ◽

Author(s):

L. Bax ◽

B. Reiter ◽

H. Reichenspurner ◽

L. Conradi

Keyword(s):

Coronary Artery ◽

Minimally Invasive ◽

Coronary Artery Bypass ◽

Coronary Artery Bypass Surgery ◽

Bypass Surgery ◽

Artery Bypass ◽

Single Center ◽

Technical Aspects ◽

Single Center Experience

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Technical Aspects for Access into the Neck (Minimally Invasive Video-Assisted Thyroidectomy — Mivat)

Endoscopic Surgery of the Potential Anatomical Spaces ◽

10.1007/1-4020-2846-6_4 ◽

2007 ◽

pp. 39-45

Author(s):

Paolo Miccoli ◽

Gabriele Materazzi

Keyword(s):

Minimally Invasive ◽

Technical Aspects ◽

Video Assisted

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Diseases of the Skeletal System

Interventional Radiology ◽

10.1093/med/9780190276249.003.0049 ◽

2018 ◽

pp. 652-666

Author(s):

Tamir Friedman ◽

James E. Brown ◽

Keith B. Quencer

Keyword(s):

Minimally Invasive ◽

Patient Care ◽

Surgical Procedures ◽

Malignant Tumors ◽

Appendicular Skeleton ◽

Diverse Group ◽

Minimally Invasive Approach ◽

Invasive Approach ◽

Technical Aspects ◽

System P

Musculoskeletal (MSK) interventions are a diverse group of procedures aimed at both therapeutic and diagnostic arenas for patient care and management. As the field evolves, MSK interventions are offering a minimally invasive approach as an alternative for open surgical procedures, such a biopsies of the axial and appendicular skeleton for diagnostic and treatment purposes, treatment of benign and malignant tumors or spinal interventions for pain or oncology therapies. However, the proceduralist must be adept with anatomy, devices and practices of referring specialties. This chapter will delve into the technical aspects of MSK procedures as well as recommendation and pitfalls of various procedures.

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Robotic-Assisted Retroperitoneoscopic Adrenalectomy: Making a Good Procedure Even Better

The American Surgeon ◽

10.1177/000313481307900135 ◽

2013 ◽

Vol 79 (1) ◽

pp. 84-89 ◽

Cited By ~ 11

Author(s):

Paxton V. Dickson ◽

Gillian C. Alex ◽

Elizabeth G. Grubbs ◽

Camilo Jimenez ◽

Jeffrey E. Lee ◽

...

Keyword(s):

Minimally Invasive ◽

Perioperative Complications ◽

Three Dimensional ◽

Invasive Procedure ◽

Robotic Assisted ◽

Surgical Technology ◽

Laparoscopic Operation ◽

Retroperitoneoscopic Adrenalectomy ◽

Postoperative Blood Transfusion ◽

Minimally Invasive Adrenalectomy

Posterior retroperitoneoscopic adrenalectomy (PRA) is a minimally invasive procedure offering several advantages over a transabdominal laparoscopic operation. The three-dimensional optics and articulating instrumentation offered by current robotic surgical technology potentially improve this procedure. Robotic-assisted PRA (RA-PRA) was performed in patients meeting standard criteria for minimally invasive adrenalectomy. We prospectively collected demographic, clinical, perioperative, and pathologic data on patients undergoing RA-PRA. Thirty consecutive RA-PRAs were performed in 28 patients (26 unilateral and 2 bilateral). Indications for adrenalectomy included pheochromocytoma (8), hyperaldosteronism (3), hypercortisolism (8), oligometastases (5), and nonfunctional tumors (6). Mean tumor size was 3.8 ± 1.6 cm. Mean body mass index was 30.7 ± 6.5 kg/m2. Mean operative time was 154 ± 43 minutes for unilateral total adrenalectomy. Four patients with multiple endocrine neoplasia Type 2A-associated pheochromocytomas underwent cortical-preserving procedures. Three patients experienced perioperative complications (one pneumothorax, one urinary retention, one required postoperative blood transfusion). No patient required conversion to an open procedure. Robotic surgical technology is an excellent complement to retroperitoneoscopic adrenalectomy. The three-dimensional view and ergonomic advantages of a robotic procedure promote better visualization and a more flexible approach to dissection. We believe these features may optimize the ability to maintain a vascularized remnant during minimally invasive cortical-sparing adrenalectomy.

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Technical Aspects: Sternotomy and Minimally Invasive Approaches

Edge-to-Edge Mitral Repair ◽

10.1007/978-3-319-19893-4_3 ◽

2015 ◽

pp. 19-29

Author(s):

Andrea Fumero ◽

Michele De Bonis

Keyword(s):

Minimally Invasive ◽

Technical Aspects

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A Robotic Approach to Stereotactic Radio-Surgery

Volume 3 ◽

10.1115/esda2004-58190 ◽

2004 ◽

Author(s):

Aldo Rossi ◽

Alberto Trevisani ◽

Alessandro Gasparetto ◽

Vanni Zanotto

Keyword(s):

Minimally Invasive ◽

Force Feedback ◽

Robotic System ◽

Load Cell ◽

Dose Delivery ◽

Clinical Tests ◽

Robotic Approach ◽

Great Precision ◽

X Ray

The aim of this paper is to present a new robotic system for minimally invasive radio surgery. The system is called DAANS and is used to move a new miniaturized x-ray source called PRS with great precision and repeatability. By means of the DAANS the PRS dose delivery center can be moved linearly along the emission axis and rotated about the same axis. Moreover the DAANS is provided with a load cell which measures the force, along the emission axis, exerted by the PRS on a patient’s tissues, and which allows generating an appropriate force feedback on a specifically developed haptic console. The system is now being manufactured and will soon be employed in clinical tests.

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