Initial experience with robotic-assisted adrenalectomy in Japan

Abstract

Objective : This study investigates the initial experiences with robot-assisted adrenalectomy.

Methods : We conducted a retrospective review of 43 patients who underwent robot-assisted adrenalectomy for adrenal tumors at Kobe University Hospital between April 2022 and April 2024. We assessed the safety and perioperative outcomes of these procedures.

Results : The median age was 56 years (range 24-81), comprising 17 males and 26 females. The diagnoses included 10 cases of non-functioning adenomas, 11 cases of primary aldosteronism, 10 pheochromocytomas, 6 subclinical Cushing’s syndrome, 5 Cushing’s syndrome, and 1 myelolipoma. Nineteen procedures targeted the right adrenal gland, while 24 were on the left. Forty-two surgeries employed a transperitoneal approach, and one used a retroperitoneal approach. The robotic systems used were the da Vinci X in 37 cases, da Vinci Xi in 4 cases, and Hinotori in 2 cases. The number of robotic arms used was three in 29 cases and four in 14 cases. The median surgical time was 151 minutes (range 78-317), median pneumoperitoneum time was 117 minutes (range 57-275), and median console (cockpit) time was 88 minutes (range 38-249). The median blood loss was minimal at 0 mL (range 0-300). There was one intraoperative complication of capsular pancreatic injury classified as Clavien-Dindo grade I ; no other perioperative complications were observed. A weak correlation was noted between the console time and both tumor size and resected weight.

Conclusion : Robot-assisted laparoscopic adrenalectomy can be safely performed with complication rates, surgical durations, and blood loss comparable to existing reports, even in an initial experience setting.