What is the advantage of laparoscopic and robotic adrenalectomy as compared to open surgery?
These minimally invasive laparoscopic techniques have translated into a significant benefit to patients including reduced blood loss and transfusions, reduced pain, shorter hospital stays, improved cosmesis, and a faster recovery as compared to open surgery. While open surgery requires either a large abdominal or flank incision, minimally invasive approaches involve 3-4 keyhole incisions in the abdomen. Published outcomes of laparoscopic and robotic adrenalectomy demonstrate comparable cure rates to open surgery.
Are there potential disadvantages?
Most patients with adrenal tumors who are candidates for open surgery are also excellent candidates for a laparoscopic or robotic approach. These minimally invasive approaches have become the standard of care for most adrenal tumors. In general there are no particular disadvantages; however, some situations may dictate the need for open surgery (see below).
What patients are not good candidates for laparoscopic and robotic adrenalectomy?
Patients with very large tumors or tumors invading surrounding structures e.g. vena cava, kidney, liver, bowel may be best served by an open approach due to the extent and need for adjacent organ resection. Medical conditions such as severe lung and heart disease may not be able to tolerate a laparoscopic or robotic approach.
What is the difference between a laparoscopic and robotic approach?
Both are laparoscopic approaches and the choice of approach is a matter of surgeon preference. Operative times, blood loss, and hospital stays are similar between a pure laparoscopic and robotic technique. These procedures are performed by inflating the abdomen with carbon dioxide gas and placing a laparoscopic lens affixed to a high definition camera into the abdomen to view the internal organs. Conventional laparoscopic surgery involves hand held instruments, while robotic surgery involves the use of a sophisticated robotic device (called the da Vinci S Surgical Robotic System) with wristed instrumentation to allow the surgeon to dissect within the abdomen while controlling these instruments externally from a surgeon console.
What happens if complications arise and conversion to open surgery is required?
Although extremely rare, conversion to open surgery may be required if difficulty with dissection is encountered during the laparoscopic approach. Our surgeons are trained in open surgical approaches as well as laparoscopy and therefore are well equipped to complete the surgery in an open fashion if needed.
What is the overall success rate of laparoscopic and robotic adrenalectomy?
Success rate in complete removal of the adrenal tumor is similar to open surgical approaches. Prognosis is generally excellent as most adrenal tumors are benign. In cases of adrenal cancer, further therapies may be required as these are generally aggressive cancers. The pathology report will be available one week following surgery and will reveal whether the tumor is benign or malignant.
Will I need further treatment such as radiation or chemotherapy following surgery?
As mentioned previously, most adrenal tumors are benign and therefore prognosis remains excellent as most are cured with surgery alone. Rarely, patients are found to have large, invasive cancers that may require adjuvant treatment under the advisement of a medical oncologist.