Single-site robotic adrenalectomy at Mayo Clinic

Jan. 17, 2020

Laparoscopic adrenalectomy was first reported in 1992. Since then, the technique has evolved into applications for nearly all patients with benign adrenal disease and for selected patients with malignant adrenal disease.

The standard of care is widely considered to be either a transabdominal laparoscopic approach or a retroperitoneoscopic approach for adrenal tumors amenable to minimally invasive surgery. More recently, the robotic technique has been adopted as an alternative for selected patients. The robotic camera provides better depth perception for the surgeon, as it offers higher resolution and a 3D view. The arms of the robot also allow for a greater range of motion than that offered by conventional laparoscopy in confined spaces.

"Endocrine surgeons at Mayo Clinic have taken this a step further by offering single-site adrenalectomy in selected patients," explains Benzon M. Dy, M.D., Endocrine Surgery, at Mayo Clinic in Rochester, Minnesota, where over 150 single-site robotic adrenalectomies have been performed. "The single-site technology allows for adrenalectomy to be safely performed through a single 2.5-cm incision. The single-site robotic port accommodates the camera, an assist port and two working hands."

A meta-analysis of robotic ― compared with laparoscopic ― adrenalectomy published in Oncotarget in 2017 shows no differences in the rate of complications, the rate of conversion to an open procedure or intraoperative blood loss. The robotic approach is associated with a longer operating time that is known to improve with surgeon experience.

"It is not a replacement for laparoscopy or standard multiport technology," reports Dr. Dy. "Rather, it complements the variety of approaches that we offer to patients so that we can provide the best approach without compromising outcomes."

Endocrine surgeons at Mayo Clinic in Rochester, Minnesota, reported on their experience using single-site robotic adrenalectomy in Surgical Endoscopy in 2016. The authors noted that they found this approach safe even in obese patients. The surgeon learning curve at Mayo Clinic was shown to result in a significant reduction in operative time after 21 surgeries.

Dr. Dy notes: "These findings suggest that centers with high-volume adrenalectomy can adopt the single-site robotic technique and overcome the concerns about operative time as surgeon experience in single-site robotic surgery builds. The robotic approach has also been shown to be less expensive, as it can be associated with a shorter hospital stay and reduced narcotic use.

"Single-site robotic adrenalectomy is not yet FDA approved, but that situation may change as surgeons such as those at Mayo Clinic report their success with this technique. Single-site robotic adrenalectomy is another example of how minimally invasive surgery is evolving to improve patient satisfaction and outcomes."

For more information

Agrusa A, et al. Innovation in endocrine surgery: Robotic versus laparoscopic adrenalectomy. Meta-analysis and systematic literature review. 2017;8:102392.

Lee GS, et al. Robotic single-site adrenalectomy. Surgical Endoscopy. 2016;30:3351.