Robotic partial adrenalectomy: initial report from two tertiary referral centers
In the era of minimally invasive surgery, partial adrenalectomy has been certainly underused. We aimed to report on postoperative and early functional outcomes of a two-center robotic partial adrenalectomy (RPA) series.
Materials and Methods
From June 2014 to October 2016 RPA was performed on 13 consecutive patients affected by non-functioning adenomas, aldosterone-secreting adenomas and pheochromocytoma (3, 9 and 1, respectively). Preoperative, postoperative and early functional outcomes data were prospectively collected and reported.
All cases were completed robotically. Median nodule size was 29 mm (range 20-40) for non-functioning adenomas, and 17.6 mm (range 10-30) for functioning adrenal masses. Intraoperative blood loss was negligible, postoperative course was uneventful in 12 cases; a single (7.7%) postoperative Clavien grade 2 complication occurred (fever requiring antibiotics); median hospital stay was 3 days (IQR 2-3.5). Patients with hyperaldosteronism became normotensive immediately after surgery (mean preoperative blood pressure: 154/93 mmHg; mean postoperative blood pressure: 120/71 mmHg, respectively). None of the patients required further hypotensive treatment.
Aldosterone and plasmatic renin activity (PRA) levels decreased and returned within the normal range after surgery (mean post-operative aldosterone: 150 pg/ml [ normal range: 17.6-232] and mean post-operative PRA:2.4 ng/ml h [range: 0.2–2.8], respectively).
Postoperative urinary metanephrines of the patient with pheochromocytoma decreased within normal range as well.
RPA is a safe, feasible and minimally invasive surgical approach. The excellent perioperative and early functional outcomes suggest an increasing adoption of this technique in the near future.
-Current trends in partial adrenalectomy.
Colleselli D1, Janetschek G.
Curr Opin Urol. 2015 Mar;25(2):89-94. doi: 10.1097/MOU.0000000000000147.