The role of robotics for adrenal pathology

Abstract

This review assesses the role of robotic surgery in management of benign and malignant adrenal disease. Laparoscopic adrenalectomy is considered the standard of care for benign adrenal neoplasms and has been increasingly considered for malignant disease. Robotic techniques have been considered for theoretical advantages in visualizing and dissecting the adrenal and its vasculature. Series of robotic adrenalectomy and limited comparisons with laparoscopic adrenalectomy have shown that robotic adrenalectomy is well tolerated and effective with subjective advantages compared with laparoscopic adrenalectomy. There has been growing interest in adrenal sparing-surgery using minimally invasive techniques and encouraging outcomes for selected benign lesions. Robotic techniques for adrenalectomy have subjective advantages compared with laparoscopic adrenalectomy, but no objective superiority has been demonstrated. Surgical outcomes have been comparable with laparoscopic adrenalectomy though there have been no randomized controlled studies. Robotic adrenalectomy will be increasingly considered in lieu of laparoscopic adrenalectomy as robotic systems further disseminate and the cost disadvantages become less prohibitive. Although laparoscopic adrenalectomy remains the standard of care, robotic adrenalectomy is an acceptable option in high volume robotic centers from standpoints of outcomes, feasibility, and cost.