Robot-assisted Partial Adrenalectomy for the Treatment of Conn's Syndrome: Surgical Technique, and Perioperative and Functional Outcomes

Giuseppe Simone, Umberto Anceschi, Gabriele Tuderti, Leonardo Misuraca, Antonio Celia, Bernardino De Concilio, Manuela Costantini, Antonio Stigliano, Francesco Minisola, Mariaconsiglia Ferriero, Salvatore Guaglianone, Michele Gallucci

Research output: Contribution to journalArticle

3 Citations (Scopus)

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 languageEnglish
JournalEuropean Urology
DOIs
Publication statusAccepted/In press - Jan 1 2018

Fingerprint

Hyperaldosteronism
Adrenalectomy
Aldosterone
Adenoma
Therapeutics
Robotics
Renin
Amlodipine
Minimally Invasive Surgical Procedures
Length of Stay
Reference Values

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 journalArticle

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. / Robot-assisted Partial Adrenalectomy for the Treatment of Conn's Syndrome : Surgical Technique, and Perioperative and Functional Outcomes. In: European Urology. 2018.
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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.",
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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

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