An intra-operative video comparison of laparoscopic versus robotic transabdominal lateral adrenalectomy

Abstract

Background: The aim was to compare intraoperative conduct of adrenalectomy between laparoscopic and robotic approaches.

Methods: Intraoperative video-recordings of patients who underwent robotic (n = 30) and laparoscopic adrenalectomy (n = 30) were analysed using Mann-Whitney U, chi-square and multivariate regression analyses.

Results: Demographics, indications and outcomes were similar between groups. For all tumour sizes, camera was more engaged to surgical task and exhibited less vision problems in robotic versus laparoscopic group. There was less instrument exchange and restriction of exposure with robotic approach. For dissection, robotic approach allowed for a wider range of instrument reach around adrenal. Robotically, there was an increased ability to do fine dissection, rather than en bloc division with rigid laparoscopic vessel sealers. Bleeding problems were less robotically.

Conclusion: Despite similarities in post-operative morbidity and hospital stay, there was a superiority in quality of procedure performed with robotic versus laparoscopic adrenalectomy for both small and large adrenal tumours.

Keywords: intraoperative comparison; laparoscopic adrenalectomy; robotic adrenalectomy; surgical technique.