Our Summary

The study looks at the effectiveness and costs of two types of minimally invasive surgery used to remove adrenal glands. One method uses a robot (robot-assisted adrenalectomy or RAA) and the other does not (laparoscopic adrenalectomy or LA).

The researchers analyzed 286 surgeries that were conducted from January 2012 to August 2021. They compared the two methods by looking at factors like the size of the lesion, hormone secretion, and body mass index (BMI) of the patients.

The results showed that the robotic method took longer (90 minutes compared to 65 minutes) but there were no differences in the length of hospital stay or the rate of complications after surgery. Also, despite the higher cost of using the robot, the income generated from both procedures was positive.

The study concluded that even though the robot-assisted method is more expensive, it is cost effective and sustainable, especially in a high-volume center performing more than 60 adrenalectomies a year. It also noted that this method is particularly useful in difficult cases, such as when dealing with large or functioning tumors.

FAQs

  1. What are the two types of minimally invasive surgery studied for removing adrenal glands?
  2. How does the robot-assisted adrenalectomy compare to the laparoscopic adrenalectomy in terms of duration, cost, and complication rate?
  3. Why is the robot-assisted method considered cost effective and sustainable despite being more expensive?

Doctor’s Tip

One helpful tip that a doctor might tell a patient about adrenalectomy is that the robot-assisted method can be a cost-effective and safe option, especially in high-volume centers. This method may be particularly beneficial for patients with large or functioning tumors. It is important for patients to discuss their options with their healthcare provider to determine the best approach for their individual case.

Suitable For

Patients who are typically recommended adrenalectomy include those with adrenal tumors, especially large or functioning tumors, patients with hormone-secreting adrenal lesions, and patients with a high BMI. Additionally, patients who are undergoing adrenalectomy in a high-volume center that performs more than 60 adrenalectomies a year may benefit from the robot-assisted method due to its cost effectiveness and sustainability.

Timeline

Before adrenalectomy:

  1. Patient presents with symptoms such as high blood pressure, weight gain, muscle weakness, and/or hormonal imbalances.
  2. Patient undergoes diagnostic tests such as blood tests, imaging scans, and possibly a biopsy to determine the need for surgery.
  3. A decision is made to proceed with adrenalectomy based on the size, hormone secretion, and location of the adrenal gland tumor.

After adrenalectomy:

  1. Patient undergoes pre-operative preparations such as fasting and anesthesia administration.
  2. Adrenalectomy is performed either through robot-assisted or laparoscopic surgery.
  3. Patient is monitored in the recovery room and then transferred to a hospital room for further observation.
  4. Patient may experience pain, fatigue, and discomfort in the days following surgery.
  5. Patient is discharged from the hospital once stable and able to manage pain at home.
  6. Follow-up appointments are scheduled to monitor recovery and assess hormone levels.
  7. Patient may need hormone replacement therapy if the remaining adrenal gland is not functioning properly.
  8. Patient gradually resumes normal activities and lifestyle as recovery progresses.

What to Ask Your Doctor

  1. What are the potential risks and complications associated with adrenalectomy, particularly with robot-assisted adrenalectomy compared to laparoscopic adrenalectomy?
  2. How does the size of the lesion, hormone secretion, and body mass index (BMI) affect the choice between robot-assisted adrenalectomy and laparoscopic adrenalectomy?
  3. Is there a difference in post-operative recovery time and pain management between the two methods?
  4. How experienced is the surgical team in performing robot-assisted adrenalectomy, and what is their success rate with this procedure?
  5. Are there any long-term effects or differences in outcomes between robot-assisted adrenalectomy and laparoscopic adrenalectomy?
  6. Will insurance cover the additional cost of robot-assisted adrenalectomy, and are there any financial assistance options available?
  7. Are there any specific criteria or characteristics that make a patient a better candidate for robot-assisted adrenalectomy over laparoscopic adrenalectomy?
  8. What follow-up care or monitoring is recommended after undergoing adrenalectomy with either method?
  9. Are there any ongoing research or advancements in the field of adrenalectomy that may impact the decision between robot-assisted and laparoscopic methods?
  10. How does the volume of adrenalectomies performed by the center or surgeon impact the recommendation for robot-assisted adrenalectomy?

Reference

Authors: De Crea C, Pennestrì F, Voloudakis N, Sessa L, Procopio PF, Gallucci P, Bellantone R, Raffaelli M. Journal: Surg Endosc. 2022 Nov;36(11):8619-8629. doi: 10.1007/s00464-022-09663-3. Epub 2022 Oct 3. PMID: 36190555