Abstract
Background: In the era of minimally invasive surgery, partial adrenalectomy has certainly been underused. We aimed to report surgical technique and perioperative, pathologic, and early functional outcomes of a two-center robot-assisted partial adrenalectomy (RAPA) series. Objective: To detail surgical technique of RAPA for unilateral aldosterone-producing adenoma (UAPA), and to report perioperative and 1-yr functional outcomes. Design, setting, and participants: Data of 10 consecutive patients who underwent RAPA for UAPA at two centers from June 2014 to April 2017 were prospectively collected and reported. Surgical procedure: RAPA was performed using a standardized technique with the da Vinci Si in a three-arm configuration. Measurements: Baseline and perioperative data were reported. One-year functional outcomes were assessed according to primary aldosteronism surgery outcome guidelines. A descriptive statistical analysis was performed. Results and limitations: All cases were completed robotically. Median nodule size was 18 mm (interquartile range [IQR] 16–20). Intraoperative blood loss was negligible. A single (10%) postoperative Clavien grade 2 complication occurred. Median hospital stay was 3 d (IQR 2–3). Patients became normotensive immediately after surgery (median pre- and postoperative blood pressure: 150/90 and 120/70 mmHg, respectively). At both 3-mo and 1-yr functional evaluation, all patients achieved biochemical success (aldosterone level, plasmatic renin activity, and aldosterone-renin ratio within normal range). Complete clinical success was achieved in nine patients, but one required low-dose amlodipine at 6-mo evaluation. At a median follow-up of 30.5 mo (IQR 19–42), neither symptoms nor imaging recurrence was observed. Conclusions: We demonstrated feasibility and safety of RAPA for UAPA; this technique had very low risk of complications and excellent functional results. Increased availability of robotic platform and increasing robotic skills among urologists make RAPA a treatment option with potential for widespread use in urologic community. Patient summary: Robot-assisted partial adrenalectomy is a safe, feasible, and minimally invasive surgical approach. Promising perioperative and functional outcomes suggest an increasing adoption of this technique in the near future. Robot-assisted partial adrenalectomy is a feasible and safe surgical option for small, isolated unilateral aldosterone-producing adenoma. The role of partial adrenalectomy (PA) versus total adrenalectomy is still a matter of debate, and indications for PA should be discussed in a multidisciplinary setting.
| Original language | English |
|---|---|
| Journal | European Urology |
| DOIs | |
| Publication status | Accepted/In press - Jan 1 2018 |
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Keywords
- Adrenal adenoma
- Adrenal sparing
- Aldosterone
- Conn's syndrome
- Partial adrenalectomy
- Robotic surgery
ASJC Scopus subject areas
- Urology
Cite this
Robot-assisted Partial Adrenalectomy for the Treatment of Conn's Syndrome : Surgical Technique, and Perioperative and Functional Outcomes. / Simone, Giuseppe; Anceschi, Umberto; Tuderti, Gabriele; Misuraca, Leonardo; Celia, Antonio; De Concilio, Bernardino; Costantini, Manuela; Stigliano, Antonio; Minisola, Francesco; Ferriero, Mariaconsiglia; Guaglianone, Salvatore; Gallucci, Michele.
In: European Urology, 01.01.2018.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Robot-assisted Partial Adrenalectomy for the Treatment of Conn's Syndrome
T2 - Surgical Technique, and Perioperative and Functional Outcomes
AU - Simone, Giuseppe
AU - Anceschi, Umberto
AU - Tuderti, Gabriele
AU - Misuraca, Leonardo
AU - Celia, Antonio
AU - De Concilio, Bernardino
AU - Costantini, Manuela
AU - Stigliano, Antonio
AU - Minisola, Francesco
AU - Ferriero, Mariaconsiglia
AU - Guaglianone, Salvatore
AU - Gallucci, Michele
PY - 2018/1/1
Y1 - 2018/1/1
N2 - Background: In the era of minimally invasive surgery, partial adrenalectomy has certainly been underused. We aimed to report surgical technique and perioperative, pathologic, and early functional outcomes of a two-center robot-assisted partial adrenalectomy (RAPA) series. Objective: To detail surgical technique of RAPA for unilateral aldosterone-producing adenoma (UAPA), and to report perioperative and 1-yr functional outcomes. Design, setting, and participants: Data of 10 consecutive patients who underwent RAPA for UAPA at two centers from June 2014 to April 2017 were prospectively collected and reported. Surgical procedure: RAPA was performed using a standardized technique with the da Vinci Si in a three-arm configuration. Measurements: Baseline and perioperative data were reported. One-year functional outcomes were assessed according to primary aldosteronism surgery outcome guidelines. A descriptive statistical analysis was performed. Results and limitations: All cases were completed robotically. Median nodule size was 18 mm (interquartile range [IQR] 16–20). Intraoperative blood loss was negligible. A single (10%) postoperative Clavien grade 2 complication occurred. Median hospital stay was 3 d (IQR 2–3). Patients became normotensive immediately after surgery (median pre- and postoperative blood pressure: 150/90 and 120/70 mmHg, respectively). At both 3-mo and 1-yr functional evaluation, all patients achieved biochemical success (aldosterone level, plasmatic renin activity, and aldosterone-renin ratio within normal range). Complete clinical success was achieved in nine patients, but one required low-dose amlodipine at 6-mo evaluation. At a median follow-up of 30.5 mo (IQR 19–42), neither symptoms nor imaging recurrence was observed. Conclusions: We demonstrated feasibility and safety of RAPA for UAPA; this technique had very low risk of complications and excellent functional results. Increased availability of robotic platform and increasing robotic skills among urologists make RAPA a treatment option with potential for widespread use in urologic community. Patient summary: Robot-assisted partial adrenalectomy is a safe, feasible, and minimally invasive surgical approach. Promising perioperative and functional outcomes suggest an increasing adoption of this technique in the near future. Robot-assisted partial adrenalectomy is a feasible and safe surgical option for small, isolated unilateral aldosterone-producing adenoma. The role of partial adrenalectomy (PA) versus total adrenalectomy is still a matter of debate, and indications for PA should be discussed in a multidisciplinary setting.
AB - Background: In the era of minimally invasive surgery, partial adrenalectomy has certainly been underused. We aimed to report surgical technique and perioperative, pathologic, and early functional outcomes of a two-center robot-assisted partial adrenalectomy (RAPA) series. Objective: To detail surgical technique of RAPA for unilateral aldosterone-producing adenoma (UAPA), and to report perioperative and 1-yr functional outcomes. Design, setting, and participants: Data of 10 consecutive patients who underwent RAPA for UAPA at two centers from June 2014 to April 2017 were prospectively collected and reported. Surgical procedure: RAPA was performed using a standardized technique with the da Vinci Si in a three-arm configuration. Measurements: Baseline and perioperative data were reported. One-year functional outcomes were assessed according to primary aldosteronism surgery outcome guidelines. A descriptive statistical analysis was performed. Results and limitations: All cases were completed robotically. Median nodule size was 18 mm (interquartile range [IQR] 16–20). Intraoperative blood loss was negligible. A single (10%) postoperative Clavien grade 2 complication occurred. Median hospital stay was 3 d (IQR 2–3). Patients became normotensive immediately after surgery (median pre- and postoperative blood pressure: 150/90 and 120/70 mmHg, respectively). At both 3-mo and 1-yr functional evaluation, all patients achieved biochemical success (aldosterone level, plasmatic renin activity, and aldosterone-renin ratio within normal range). Complete clinical success was achieved in nine patients, but one required low-dose amlodipine at 6-mo evaluation. At a median follow-up of 30.5 mo (IQR 19–42), neither symptoms nor imaging recurrence was observed. Conclusions: We demonstrated feasibility and safety of RAPA for UAPA; this technique had very low risk of complications and excellent functional results. Increased availability of robotic platform and increasing robotic skills among urologists make RAPA a treatment option with potential for widespread use in urologic community. Patient summary: Robot-assisted partial adrenalectomy is a safe, feasible, and minimally invasive surgical approach. Promising perioperative and functional outcomes suggest an increasing adoption of this technique in the near future. Robot-assisted partial adrenalectomy is a feasible and safe surgical option for small, isolated unilateral aldosterone-producing adenoma. The role of partial adrenalectomy (PA) versus total adrenalectomy is still a matter of debate, and indications for PA should be discussed in a multidisciplinary setting.
KW - Adrenal adenoma
KW - Adrenal sparing
KW - Aldosterone
KW - Conn's syndrome
KW - Partial adrenalectomy
KW - Robotic surgery
UR - http://www.scopus.com/inward/record.url?scp=85050796919&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85050796919&partnerID=8YFLogxK
U2 - 10.1016/j.eururo.2018.07.030
DO - 10.1016/j.eururo.2018.07.030
M3 - Article
AN - SCOPUS:85050796919
JO - European Urology
JF - European Urology
SN - 0302-2838
ER -