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Robotic versus laparoscopic adrenalectomy in obese patients

机译：肥胖患者的机器人与腹腔镜肾上腺切除术

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Background: Recently, we demonstrated better perioperative outcomes with robotic versus laparoscopic adrenalectomy (LA) with the posterior retroperitoneal approach in general, and for removal of large adrenal tumors. It is unknown if robotic adrenalectomy (RA) is equivalent to LA in obese patients. The aim of this study is to compare perioperative outcomes of RA versus LA in obese patients. Methods: Between 2003 and 2012, 99 obese (BMI ≥ 30 kg/m 2) patients underwent adrenalectomy at a tertiary academic center. Of these, 42 patients had RA and 57 had LA. The perioperative outcomes of these patients were compared between the RA and LA groups. Data were collected from a prospectively maintained, institutional review board approved database. Clinical and perioperative parameters were analyzed using Student t and χ2 tests. All data are expressed as mean ± standard error of the mean. Results: The groups were similar in terms of age, gender, and tumor side. Body mass index was lower in the robotic versus laparoscopic group (35.4 ± 1.0 vs. 38.8 ± 0.8 kg/m2, respectively, p = 0.01). Tumor size (4.0 ± 0.4 vs. 4.3 ± 0.3 cm, respectively, p = 0.56), skin-to-skin operative time (186.1 ± 12.1 vs. 187.3 ± 11 min, respectively, p = 0.94), estimated blood loss (50.3 ± 24.3 vs. 76.6 ± 21.3 ml, respectively, p = 0.42), and hospital stay (1.3 ± 0.1 vs. 1.6 ± 0.1 days, respectively, p = 0.06) were similar in both groups. The conversion to open rate was zero in the robotic and 5.2 % in the laparoscopic group (p = 0.06). The 30-day morbidity was 4.8 % in the robotic and 7 % in the laparoscopic group (p = 0.63). Conclusions: Our study did not show any difference in perioperative outcomes between RA and LA in obese patients. These results suggest that the difficulties in maintaining exposure and dissection in obese patients nullify the advantages of robotic articulating versus rigid laparoscopic instruments in adrenal surgery.
机译：背景：最近，我们证明机器人腹腔镜肾上腺切除术（LA）与腹膜后后入路相比，在腹腔镜肾上腺切除术（LA）上具有更好的围手术期效果，并且可以清除大的肾上腺肿瘤。尚不清楚肥胖患者中机器人肾上腺切除术（RA）是否等同于LA。这项研究的目的是比较肥胖患者的RA与LA围手术期结局。方法：在2003年至2012年之间，有99名肥胖（BMI≥30 kg / m 2）患者在大专院校接受了肾上腺切除术。其中42例患者患有RA，57例患者患有LA。在RA和LA组之间比较了这些患者的围手术期结局。数据是从前瞻性维护，机构审查委员会批准的数据库中收集的。使用Student t和χ2检验分析临床和围手术期参数。所有数据均表示为平均值±平均值的标准误。结果：各组在年龄，性别和肿瘤侧方面相似。机器人组与腹腔镜组的体重指数较低（分别为35.4±1.0和38.8±0.8 kg / m2，p = 0.01）。肿瘤大小（分别为4.0±0.4 vs.4.3±0.3 cm，p = 0.56），皮肤到皮肤的手术时间（分别为186.1±12.1 vs.187.3±11 min，p = 0.94），估计失血量（50.3两组分别为±24.3 vs. 76.6±21.3 ml，p = 0.42）和住院时间（分别为1.3±0.1 vs. 1.6±0.1天，p = 0.06）。机械手的开门率转换为零，腹腔镜组的开门率转换为5.2％（p = 0.06）。机械手的30天发病率为4.8％，腹腔镜手术组为7％（p = 0.63）。结论：我们的研究未显示肥胖患者的RA和LA围手术期结局有任何差异。这些结果表明，在肥胖患者中维持暴露和解剖的困难使肾上腺手术中机器人铰接式器械与刚性腹腔镜器械的优势无效。

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