Robot-assisted adrenalectomy: indications and drawbacks.
Fiche publication
Date publication
mai 2017
Journal
Updates in surgery
Auteurs
Membres identifiés du Cancéropôle Est :
Pr AYAV Ahmet, Pr GERMAIN Adeline
Tous les auteurs :
Nomine-Criqui C, Germain A, Ayav A, Bresler L, Brunaud L
Lien Pubmed
Résumé
Adrenal tumors can vary from a benign adrenocortical adenoma with no hormonal secretion to a secretory adrenocortical malignancy (adrenocortical carcinoma) or a hormone-secreting tumor of the adrenal medulla (pheochromocytoma). Currently, laparoscopic adrenalectomy is regarded as the preferred surgical approach for the management of most adrenal surgical disorders, although there are no prospective randomized trials comparing this technique with open adrenalectomy. However, widespread adoption of robotic technology has positioned robotic adrenalectomy as an option in some medical centers. Speculative advantages associated with the use of the robotic system have rarely been evaluated in clinical settings and cost increase remains an important drawback associated with robotic surgery. This review summarizes current available data regarding robotic transperitoneal adrenalectomy including its indications, advantages, limitations, and comparison with conventional laparoscopic adrenalectomy. We believe that the use of a robotic system seems to be useful especially in more difficult patients with larger tumors, truncal paragangliomas, and bilateral and/or partial adrenalectomies. Overall, we believe that overcosts due to robotic system use could be balanced by hospital stay decrease, patients' referral increase, improved postoperative outcomes in more difficult patients and ergonomics for the surgeon. However, we also believe that the current surgical intuitive business model is counterproductive, because there are no available strong clinical data that could balance overcosts associated with the use of the robotic system.
Mots clés
Adrenal glands, Adrenalectomy, Laparoscopy, Pheochromocytoma, Robotics, Telerobotics
Référence
Updates Surg. 2017 May;: