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REVIEW ARTICLE

Robot‑assisted adrenalectomy: state of the art Gabriele Materazzi1   · Leonardo Rossi1 Received: 27 May 2020 / Accepted: 26 October 2020 © The Author(s) 2020

Abstract Currently, laparoscopic adrenalectomy is worldwide considered the gold standard technique. Both transperitoneal and retroperitoneal approaches have proved their efficacy with excellent outcomes. Since the introduction of da Vinci System (Intuitive Surgical, Sunnyvale, CA), robotic surgery has made many steps forward gaining progressively more diffusion in the field of general and endocrine surgery. The robotic technique offers advantages to overcome some laparoscopic shortcomings (rigid instruments, loss of 3D vision, unstable camera). Indeed, the robotic system is provided of stereoscopic 3D-magnified vision, additional degree of freedom, tremor-filtering technology and a stable camera. Recently, several case series have demonstrated the feasibility and the safety of robot-assisted adrenalectomy in high-volume centers with outcomes comparable to laparoscopic adrenalectomy. Notwithstanding, the technical advantages of the robotic system have not yet demonstrated significant improvements in terms of outcomes to undermine laparoscopic adrenalectomy. Moreover, robotic adrenalectomy harbor inherits drawbacks, such as longer operative time and elevated costs, that limit its use. In particular, the high cost associated with the use of the robotic system is primarily related to the purchase and the maintenance of the unit, the high instruments cost and the longer operative time. Notably, these aspects make robotic adrenalectomy up to 2.3 times more costly than laparoscopic adrenalectomy. This literature review summarizes the current available studies and provides an overview about the robotic scenario including applicability, technical details and surgical outcomes. Keywords  Robotic · Adrenalectomy · Adrenal gland · Laparoscopic · Retroperitoneal

Introduction The first successful laparoscopic adrenalectomy (LA) was described by Gagner et al. in 1992 [1]. Although initially adopted for the management of small benign lesions, currently LA is worldwide considered the gold standard technique for the treatment of functional and non-functional adrenal lesions with reported masses up to 11–12 cm in size [2–4]. LA has proved to be safe and should be preferred to open adrenalectomy due to shorter length hospital stay, lower blood loss and equivalent morbidity, except for selected cases, such as malignant tumors potentially

* Gabriele Materazzi [email protected] Leonardo Rossi [email protected] 1



Department of Surgical, Medical and Molecular Pathology and Critical Area, Endocrine Surgery Unit, University of Pisa, Pisa Hospital, Via Paradisa 2, Edificio 30 J, 56100 Pisa, Italy

infiltrating surrounding organs [4]. Nonetheless, recently the frequency of minimally invasive surgery for adrenocortical carcinoma is increasing although further studies are needed to define its role in the treatment of malignancy [5, 6]. Further, the superi