ROBOTIC ASSISTED VERSUS PURE LAPAROSCOPIC SURGERY OF THE ADRENAL GLANDS: A CASE-CONTROL STUDY COMPARING SURGICAL TECHNIQUES

AIM: The role of da Vinci® System in adrenal gland surgery is not well-defined yet. This case-controlled study aims to compare robotic assisted surgery with pure laparoscopic surgery, in the authors’ monocentric experience. MATERIALS AND METHODS: 116 patients underwent minimally invasive adrenalectomies in our Department between June 1994 and December 2014: 75 with pure laparoscopic surgery (LS), whereas 41 with da Vinci® robotic system (RS). This case-controlled study was performed comparing 19 patients operated with RS and 19 operated with LS according to BMI, age, laterality and neoplasia dimensions. The two groups were compared for clinical and surgical data. Patients of each group were divided in subgroups according to nodule dimensions (< 3 cm, between 3 and 6 cm, ≥ 6 cm). Statistical analysis was performed with Student’s t-test for independent samples. Value of p < 0.01 was considered significant. RESULTS: The laparoscopic group of this case-controlled study showed a significant increase of operative time in patients with malignancy, in those with BMI ≥ 30 kg/m2 and with nodules > 6 cm (p < 0.01). This trend was not evidenced in the robotic group (p = NS). The direct comparison between RS and LS did not reveal differences in the operative time with nodules < 3 cm or between 3 and 6 cm, whereas with nodules ≥ 6 cm the robotic group operative time resulted significantly lower compared to the laparoscopic group (163.3 vs. 276.4 minutes; p < 0.01). Conversions to open surgery were 2 for the laparoscopic group and 0 for the robotic group. Postsurgical complications were 2 and 0 respectively. No reoperations or deceased patients occurred. CONCLUSIONS: In our experience, robotic system in adrenal gland surgery showed potential benefits compared to classic laparoscopy in patients with malignancy, BMI ≥ 30 kg/m2 and neoplasia > 6 cm.