Treatment Outcomes of Robotic Adrenalectomy Compared to Laparoscopic Adrenalectomy: A Propensity Score Matching Study

Abstract

INTRODUCTION: Laparoscopic adrenalectomy is a common procedure for the treatment of adrenal tumors. However, the recent inclusion of robotic adrenalectomy in the list of insurance-covered procedures in Japan since April 2022 has raised questions regarding its broader clinical utility. This study aimed to elucidate the treatment outcomes of robotic adrenalectomy and conduct a comprehensive analysis comparing laparoscopic and robotic adrenalectomies. METHODS: The baseline characteristics of patients and perioperative outcomes between laparoscopic and robotic adrenalectomies performed at Hiroshima University in July 2022 using the da Vinci Si, da Vinci Xi, and Hinotori were compared. Propensity score matching was performed to compare the outcomes of laparoscopic and robotic adrenalectomies. RESULTS: Laparoscopic and robotic adrenalectomies were performed in 292 and 43 patients, respectively. There were no statistically significant differences between equipment. In the baseline characteristics of patients, the body mass index of the laparoscopic adrenalectomy group was smaller than that of the robotic adrenalectomy group. As for perioperative outcomes, the length of stay and number of complications were less for robotic adrenalectomy than for laparoscopic adrenalectomy. After matching for the body mass index, robotic adrenalectomy showed less bleeding and fewer intraoperative complications than laparoscopic adrenalectomy. However, after matching for general factors, patients with robotic adrenalectomy had shorter hospital stays and fewer intraoperative complications. CONCLUSIONS: Compared with laparoscopic adrenalectomy, robotic adrenalectomy can be performed safely with fewer intraoperative complications and may also have shorter hospital stays and minimal bleeding.