Laparoscopic versus robotic adrenalectomy in severely obese patients
Background Over the last 20 years, the prevalence of severe obesity (body mass index ≥ 35 kg/m 2 ) has almost doubled. This condition increases the challenge of laparoscopic adrenalectomy (LA) by creating problems with instrument reach, adequate exposure, and visualization. The aim was to compare pe...
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| Veröffentlicht in: | Surgical endoscopy 2023-02, Vol.37 (2), p.1107-1113 |
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| creator | Isiktas, Gizem Avci, Seyma Nazli Erten, Ozgun Ergun, Onuralp Krishnamurthy, Vikram Shin, Joyce Siperstein, Allan Berber, Eren |
| description | Background
Over the last 20 years, the prevalence of severe obesity (body mass index ≥ 35 kg/m
2
) has almost doubled. This condition increases the challenge of laparoscopic adrenalectomy (LA) by creating problems with instrument reach, adequate exposure, and visualization. The aim was to compare perioperative outcomes of laparoscopic versus robotic adrenalectomy (RA) in severely obese patients.
Methods
This was an institutional review board-approved retrospective study. Prospectively collected clinical parameters of patients who underwent LA versus RA between 2000 and 2021 at a single center were compared using Mann–Whitney
U
, ANOVA, Chi-square, and multivariate regression analysis. Continuous data are expressed as median (interquartile range).
Results
For lateral transabdominal (LT) adrenalectomies, skin-to-skin operative time (OT) [164.5 (71.0) vs 198.8 (117.0) minutes,
p
= 0.006] and estimated blood loss [26.2 (15.0) vs 72.6 (50.0) ml,
p
= 0.010] were less in RA versus LA group, respectively. Positive margin rate, hospital stay and 90-day morbidity were similar between the groups (
p
= NS). For posterior retroperitoneal (PR) approach, operative time and perioperative outcomes were similar between LA and RA groups. Multivariate analysis demonstrated robotic versus laparoscopic technique (
p
= 0.006) to be an independent predictor of a shorter OT.
Conclusion
There was a benefit of robotic over the laparoscopic LT adrenalectomy regarding OT and estimated blood loss. Although limited by the small sample size, there was no difference regarding perioperative outcomes between RA and LA performed through a PR approach. |
| doi_str_mv | 10.1007/s00464-022-09594-z |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2716088344</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2778480136</sourcerecordid><originalsourceid>FETCH-LOGICAL-c305t-74b6c0e5bf7a0b24c13df2f4f35ab98e58faac1612045c31247f3359feeee6ab3</originalsourceid><addsrcrecordid>eNp9kMlOwzAQhi0EoqXwAhxQJC5cAuMtyxGVVarEBc6W445RqjQOdoLUPj0uYZE44MvI8jf_eD5CTilcUoD8KgCITKTAWAqlLEW63SNTKjhLGaPFPplCySFleSkm5CiEFUS-pPKQTHhGGZdCTMnNQnfau2BcV5vkHX0YQuJd5fp41UuPrW7Q9G69Seo2CRgJbDaJqzBg0um-xrYPx-TA6ibgyVedkZe72-f5Q7p4un-cXy9Sw0H2aS6qzADKyuYaKiYM5UvLrLBc6qosUBZWa0Pj30BIwykTueVclhbjyXTFZ-RizO28exsw9GpdB4NNo1t0Q1AspxkUBRcioud_0JUbfFxmR-WFKIDyLFJspExUEDxa1fl6rf1GUVA7x2p0rKJj9elYbWPT2Vf0UK1x-dPyLTUCfARCfGpf0f_O_if2A-K8iCE</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2778480136</pqid></control><display><type>article</type><title>Laparoscopic versus robotic adrenalectomy in severely obese patients</title><source>MEDLINE</source><source>SpringerLink Journals - AutoHoldings</source><creator>Isiktas, Gizem ; Avci, Seyma Nazli ; Erten, Ozgun ; Ergun, Onuralp ; Krishnamurthy, Vikram ; Shin, Joyce ; Siperstein, Allan ; Berber, Eren</creator><creatorcontrib>Isiktas, Gizem ; Avci, Seyma Nazli ; Erten, Ozgun ; Ergun, Onuralp ; Krishnamurthy, Vikram ; Shin, Joyce ; Siperstein, Allan ; Berber, Eren</creatorcontrib><description>Background
Over the last 20 years, the prevalence of severe obesity (body mass index ≥ 35 kg/m
2
) has almost doubled. This condition increases the challenge of laparoscopic adrenalectomy (LA) by creating problems with instrument reach, adequate exposure, and visualization. The aim was to compare perioperative outcomes of laparoscopic versus robotic adrenalectomy (RA) in severely obese patients.
Methods
This was an institutional review board-approved retrospective study. Prospectively collected clinical parameters of patients who underwent LA versus RA between 2000 and 2021 at a single center were compared using Mann–Whitney
U
, ANOVA, Chi-square, and multivariate regression analysis. Continuous data are expressed as median (interquartile range).
Results
For lateral transabdominal (LT) adrenalectomies, skin-to-skin operative time (OT) [164.5 (71.0) vs 198.8 (117.0) minutes,
p
= 0.006] and estimated blood loss [26.2 (15.0) vs 72.6 (50.0) ml,
p
= 0.010] were less in RA versus LA group, respectively. Positive margin rate, hospital stay and 90-day morbidity were similar between the groups (
p
= NS). For posterior retroperitoneal (PR) approach, operative time and perioperative outcomes were similar between LA and RA groups. Multivariate analysis demonstrated robotic versus laparoscopic technique (
p
= 0.006) to be an independent predictor of a shorter OT.
Conclusion
There was a benefit of robotic over the laparoscopic LT adrenalectomy regarding OT and estimated blood loss. Although limited by the small sample size, there was no difference regarding perioperative outcomes between RA and LA performed through a PR approach.</description><identifier>ISSN: 0930-2794</identifier><identifier>EISSN: 1432-2218</identifier><identifier>DOI: 10.1007/s00464-022-09594-z</identifier><identifier>PMID: 36123544</identifier><language>eng</language><publisher>New York: Springer US</publisher><subject>Abdominal Surgery ; Adrenal Gland Neoplasms - surgery ; Adrenalectomy - methods ; Body mass index ; Endoscopy ; Gastroenterology ; Gynecology ; Hepatology ; Hospitals ; Humans ; Laparoscopy ; Laparoscopy - methods ; Medicine ; Medicine & Public Health ; Multivariate analysis ; Obesity ; Obesity - surgery ; Original Article ; Proctology ; Retrospective Studies ; Robotic surgery ; Robotic Surgical Procedures - methods ; Sealing compounds ; Skin ; Surgery ; Surgical outcomes ; Tumors</subject><ispartof>Surgical endoscopy, 2023-02, Vol.37 (2), p.1107-1113</ispartof><rights>The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature 2022. Springer Nature or its licensor holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.</rights><rights>2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c305t-74b6c0e5bf7a0b24c13df2f4f35ab98e58faac1612045c31247f3359feeee6ab3</citedby><cites>FETCH-LOGICAL-c305t-74b6c0e5bf7a0b24c13df2f4f35ab98e58faac1612045c31247f3359feeee6ab3</cites><orcidid>0000-0003-4378-1794</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00464-022-09594-z$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00464-022-09594-z$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,776,780,27901,27902,41464,42533,51294</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/36123544$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Isiktas, Gizem</creatorcontrib><creatorcontrib>Avci, Seyma Nazli</creatorcontrib><creatorcontrib>Erten, Ozgun</creatorcontrib><creatorcontrib>Ergun, Onuralp</creatorcontrib><creatorcontrib>Krishnamurthy, Vikram</creatorcontrib><creatorcontrib>Shin, Joyce</creatorcontrib><creatorcontrib>Siperstein, Allan</creatorcontrib><creatorcontrib>Berber, Eren</creatorcontrib><title>Laparoscopic versus robotic adrenalectomy in severely obese patients</title><title>Surgical endoscopy</title><addtitle>Surg Endosc</addtitle><addtitle>Surg Endosc</addtitle><description>Background
Over the last 20 years, the prevalence of severe obesity (body mass index ≥ 35 kg/m
2
) has almost doubled. This condition increases the challenge of laparoscopic adrenalectomy (LA) by creating problems with instrument reach, adequate exposure, and visualization. The aim was to compare perioperative outcomes of laparoscopic versus robotic adrenalectomy (RA) in severely obese patients.
Methods
This was an institutional review board-approved retrospective study. Prospectively collected clinical parameters of patients who underwent LA versus RA between 2000 and 2021 at a single center were compared using Mann–Whitney
U
, ANOVA, Chi-square, and multivariate regression analysis. Continuous data are expressed as median (interquartile range).
Results
For lateral transabdominal (LT) adrenalectomies, skin-to-skin operative time (OT) [164.5 (71.0) vs 198.8 (117.0) minutes,
p
= 0.006] and estimated blood loss [26.2 (15.0) vs 72.6 (50.0) ml,
p
= 0.010] were less in RA versus LA group, respectively. Positive margin rate, hospital stay and 90-day morbidity were similar between the groups (
p
= NS). For posterior retroperitoneal (PR) approach, operative time and perioperative outcomes were similar between LA and RA groups. Multivariate analysis demonstrated robotic versus laparoscopic technique (
p
= 0.006) to be an independent predictor of a shorter OT.
Conclusion
There was a benefit of robotic over the laparoscopic LT adrenalectomy regarding OT and estimated blood loss. Although limited by the small sample size, there was no difference regarding perioperative outcomes between RA and LA performed through a PR approach.</description><subject>Abdominal Surgery</subject><subject>Adrenal Gland Neoplasms - surgery</subject><subject>Adrenalectomy - methods</subject><subject>Body mass index</subject><subject>Endoscopy</subject><subject>Gastroenterology</subject><subject>Gynecology</subject><subject>Hepatology</subject><subject>Hospitals</subject><subject>Humans</subject><subject>Laparoscopy</subject><subject>Laparoscopy - methods</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Multivariate analysis</subject><subject>Obesity</subject><subject>Obesity - surgery</subject><subject>Original Article</subject><subject>Proctology</subject><subject>Retrospective Studies</subject><subject>Robotic surgery</subject><subject>Robotic Surgical Procedures - methods</subject><subject>Sealing compounds</subject><subject>Skin</subject><subject>Surgery</subject><subject>Surgical outcomes</subject><subject>Tumors</subject><issn>0930-2794</issn><issn>1432-2218</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><recordid>eNp9kMlOwzAQhi0EoqXwAhxQJC5cAuMtyxGVVarEBc6W445RqjQOdoLUPj0uYZE44MvI8jf_eD5CTilcUoD8KgCITKTAWAqlLEW63SNTKjhLGaPFPplCySFleSkm5CiEFUS-pPKQTHhGGZdCTMnNQnfau2BcV5vkHX0YQuJd5fp41UuPrW7Q9G69Seo2CRgJbDaJqzBg0um-xrYPx-TA6ibgyVedkZe72-f5Q7p4un-cXy9Sw0H2aS6qzADKyuYaKiYM5UvLrLBc6qosUBZWa0Pj30BIwykTueVclhbjyXTFZ-RizO28exsw9GpdB4NNo1t0Q1AspxkUBRcioud_0JUbfFxmR-WFKIDyLFJspExUEDxa1fl6rf1GUVA7x2p0rKJj9elYbWPT2Vf0UK1x-dPyLTUCfARCfGpf0f_O_if2A-K8iCE</recordid><startdate>20230201</startdate><enddate>20230201</enddate><creator>Isiktas, Gizem</creator><creator>Avci, Seyma Nazli</creator><creator>Erten, Ozgun</creator><creator>Ergun, Onuralp</creator><creator>Krishnamurthy, Vikram</creator><creator>Shin, Joyce</creator><creator>Siperstein, Allan</creator><creator>Berber, Eren</creator><general>Springer US</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0003-4378-1794</orcidid></search><sort><creationdate>20230201</creationdate><title>Laparoscopic versus robotic adrenalectomy in severely obese patients</title><author>Isiktas, Gizem ; Avci, Seyma Nazli ; Erten, Ozgun ; Ergun, Onuralp ; Krishnamurthy, Vikram ; Shin, Joyce ; Siperstein, Allan ; Berber, Eren</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c305t-74b6c0e5bf7a0b24c13df2f4f35ab98e58faac1612045c31247f3359feeee6ab3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Abdominal Surgery</topic><topic>Adrenal Gland Neoplasms - surgery</topic><topic>Adrenalectomy - methods</topic><topic>Body mass index</topic><topic>Endoscopy</topic><topic>Gastroenterology</topic><topic>Gynecology</topic><topic>Hepatology</topic><topic>Hospitals</topic><topic>Humans</topic><topic>Laparoscopy</topic><topic>Laparoscopy - methods</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Multivariate analysis</topic><topic>Obesity</topic><topic>Obesity - surgery</topic><topic>Original Article</topic><topic>Proctology</topic><topic>Retrospective Studies</topic><topic>Robotic surgery</topic><topic>Robotic Surgical Procedures - methods</topic><topic>Sealing compounds</topic><topic>Skin</topic><topic>Surgery</topic><topic>Surgical outcomes</topic><topic>Tumors</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Isiktas, Gizem</creatorcontrib><creatorcontrib>Avci, Seyma Nazli</creatorcontrib><creatorcontrib>Erten, Ozgun</creatorcontrib><creatorcontrib>Ergun, Onuralp</creatorcontrib><creatorcontrib>Krishnamurthy, Vikram</creatorcontrib><creatorcontrib>Shin, Joyce</creatorcontrib><creatorcontrib>Siperstein, Allan</creatorcontrib><creatorcontrib>Berber, Eren</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>Surgical endoscopy</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Isiktas, Gizem</au><au>Avci, Seyma Nazli</au><au>Erten, Ozgun</au><au>Ergun, Onuralp</au><au>Krishnamurthy, Vikram</au><au>Shin, Joyce</au><au>Siperstein, Allan</au><au>Berber, Eren</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Laparoscopic versus robotic adrenalectomy in severely obese patients</atitle><jtitle>Surgical endoscopy</jtitle><stitle>Surg Endosc</stitle><addtitle>Surg Endosc</addtitle><date>2023-02-01</date><risdate>2023</risdate><volume>37</volume><issue>2</issue><spage>1107</spage><epage>1113</epage><pages>1107-1113</pages><issn>0930-2794</issn><eissn>1432-2218</eissn><abstract>Background
Over the last 20 years, the prevalence of severe obesity (body mass index ≥ 35 kg/m
2
) has almost doubled. This condition increases the challenge of laparoscopic adrenalectomy (LA) by creating problems with instrument reach, adequate exposure, and visualization. The aim was to compare perioperative outcomes of laparoscopic versus robotic adrenalectomy (RA) in severely obese patients.
Methods
This was an institutional review board-approved retrospective study. Prospectively collected clinical parameters of patients who underwent LA versus RA between 2000 and 2021 at a single center were compared using Mann–Whitney
U
, ANOVA, Chi-square, and multivariate regression analysis. Continuous data are expressed as median (interquartile range).
Results
For lateral transabdominal (LT) adrenalectomies, skin-to-skin operative time (OT) [164.5 (71.0) vs 198.8 (117.0) minutes,
p
= 0.006] and estimated blood loss [26.2 (15.0) vs 72.6 (50.0) ml,
p
= 0.010] were less in RA versus LA group, respectively. Positive margin rate, hospital stay and 90-day morbidity were similar between the groups (
p
= NS). For posterior retroperitoneal (PR) approach, operative time and perioperative outcomes were similar between LA and RA groups. Multivariate analysis demonstrated robotic versus laparoscopic technique (
p
= 0.006) to be an independent predictor of a shorter OT.
Conclusion
There was a benefit of robotic over the laparoscopic LT adrenalectomy regarding OT and estimated blood loss. Although limited by the small sample size, there was no difference regarding perioperative outcomes between RA and LA performed through a PR approach.</abstract><cop>New York</cop><pub>Springer US</pub><pmid>36123544</pmid><doi>10.1007/s00464-022-09594-z</doi><tpages>7</tpages><orcidid>https://orcid.org/0000-0003-4378-1794</orcidid></addata></record> |
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| source | MEDLINE; SpringerLink Journals - AutoHoldings |
| subjects | Abdominal Surgery Adrenal Gland Neoplasms - surgery Adrenalectomy - methods Body mass index Endoscopy Gastroenterology Gynecology Hepatology Hospitals Humans Laparoscopy Laparoscopy - methods Medicine Medicine & Public Health Multivariate analysis Obesity Obesity - surgery Original Article Proctology Retrospective Studies Robotic surgery Robotic Surgical Procedures - methods Sealing compounds Skin Surgery Surgical outcomes Tumors |
| title | Laparoscopic versus robotic adrenalectomy in severely obese patients |
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