Nomine-Criqui C, Germain A, Ayav A, Bresler L, Brunaud L
Department of Digestive, Hepatobiliary, Endocrine, and Oncology Surgery, University of Lorraine, CHU Nancy-Brabois (Adultes), 54511, Vandoeuvre-Les-Nancy, France.
Unité INSERM U954, Faculté de Médecine, University of Lorraine, 54511, Vandoeuvre-Les-Nancy, France.
Updates Surg. 2017 Jun;69(2):127-133. doi: 10.1007/s13304-017-0448-6. Epub 2017 May 12.
Adrenal tumors can vary from a benign adrenocortical adenoma with no hormonal secretion to a secretory adrenocortical malignancy (adrenocortical carcinoma) or a hormone-secreting tumor of the adrenal medulla (pheochromocytoma). Currently, laparoscopic adrenalectomy is regarded as the preferred surgical approach for the management of most adrenal surgical disorders, although there are no prospective randomized trials comparing this technique with open adrenalectomy. However, widespread adoption of robotic technology has positioned robotic adrenalectomy as an option in some medical centers. Speculative advantages associated with the use of the robotic system have rarely been evaluated in clinical settings and cost increase remains an important drawback associated with robotic surgery. This review summarizes current available data regarding robotic transperitoneal adrenalectomy including its indications, advantages, limitations, and comparison with conventional laparoscopic adrenalectomy. We believe that the use of a robotic system seems to be useful especially in more difficult patients with larger tumors, truncal paragangliomas, and bilateral and/or partial adrenalectomies. Overall, we believe that overcosts due to robotic system use could be balanced by hospital stay decrease, patients' referral increase, improved postoperative outcomes in more difficult patients and ergonomics for the surgeon. However, we also believe that the current surgical intuitive business model is counterproductive, because there are no available strong clinical data that could balance overcosts associated with the use of the robotic system.
肾上腺肿瘤的范围很广，从无激素分泌的良性肾上腺皮质腺瘤到分泌性肾上腺皮质恶性肿瘤（肾上腺皮质癌）或肾上腺髓质的激素分泌肿瘤（嗜铬细胞瘤）。目前，腹腔镜肾上腺切除术被视为治疗大多数肾上腺外科疾病的首选手术方法，尽管尚无前瞻性随机试验将该技术与开放性肾上腺切除术进行比较。然而，机器人技术的广泛应用使机器人肾上腺切除术在一些医疗中心成为一种选择。与使用机器人系统相关的推测性优势在临床环境中很少得到评估，而且成本增加仍然是机器人手术的一个重要缺点。本综述总结了目前关于机器人经腹肾上腺切除术的可用数据，包括其适应证、优势、局限性以及与传统腹腔镜肾上腺切除术的比较。我们认为，机器人系统的使用似乎特别有助于治疗病情更复杂的患者，如肿瘤较大的患者、躯干副神经节瘤患者以及需要进行双侧和/或部分肾上腺切除术的患者。总体而言，我们认为，使用机器人系统导致的成本过高可以通过缩短住院时间、增加患者转诊、改善病情更复杂患者的术后结果以及提高外科医生的操作舒适度来平衡。然而，我们也认为，目前的手术直观商业模式适得其反，因为没有有力的临床数据能够平衡与使用机器人系统相关的成本过高问题。
