Department of Surgical, Medical and Molecular Pathology and Critical Area, Endocrine Surgery Unit, University of Pisa, Pisa Hospital, Via Paradisa 2, Edificio 30 J, 56100, Pisa, Italy.
Updates Surg. 2021 Jun;73(3):1131-1146. doi: 10.1007/s13304-020-00915-2. Epub 2020 Nov 11.
Currently, laparoscopic adrenalectomy is worldwide considered the gold standard technique. Both transperitoneal and retroperitoneal approaches have proved their efficacy with excellent outcomes. Since the introduction of da Vinci System (Intuitive Surgical, Sunnyvale, CA), robotic surgery has made many steps forward gaining progressively more diffusion in the field of general and endocrine surgery. The robotic technique offers advantages to overcome some laparoscopic shortcomings (rigid instruments, loss of 3D vision, unstable camera). Indeed, the robotic system is provided of stereoscopic 3D-magnified vision, additional degree of freedom, tremor-filtering technology and a stable camera. Recently, several case series have demonstrated the feasibility and the safety of robot-assisted adrenalectomy in high-volume centers with outcomes comparable to laparoscopic adrenalectomy. Notwithstanding, the technical advantages of the robotic system have not yet demonstrated significant improvements in terms of outcomes to undermine laparoscopic adrenalectomy. Moreover, robotic adrenalectomy harbor inherits drawbacks, such as longer operative time and elevated costs, that limit its use. In particular, the high cost associated with the use of the robotic system is primarily related to the purchase and the maintenance of the unit, the high instruments cost and the longer operative time. Notably, these aspects make robotic adrenalectomy up to 2.3 times more costly than laparoscopic adrenalectomy. This literature review summarizes the current available studies and provides an overview about the robotic scenario including applicability, technical details and surgical outcomes.
目前,腹腔镜肾上腺切除术被全世界公认为金标准技术。经腹腔和后腹腔入路都已被证明具有良好的疗效。自从达芬奇手术系统(直觉外科公司,加利福尼亚州森尼韦尔)问世以来,机器人手术在普通和内分泌外科领域取得了许多进展,越来越普及。机器人技术具有克服一些腹腔镜缺点(器械僵硬、3D 视觉丧失、摄像机不稳定)的优势。事实上,机器人系统提供了立体 3D 放大视觉、更多的自由度、震颤过滤技术和稳定的摄像机。最近,一些病例系列研究表明,在高容量中心,机器人辅助肾上腺切除术具有可行性和安全性,其结果可与腹腔镜肾上腺切除术相媲美。然而,机器人系统的技术优势在手术结果方面尚未显示出显著改善,从而无法取代腹腔镜肾上腺切除术。此外,机器人肾上腺切除术还存在一些固有缺陷,如手术时间较长和成本较高,这限制了其应用。特别是,使用机器人系统的高昂成本主要与购买和维护设备、高器械成本以及较长的手术时间有关。值得注意的是,这些方面使得机器人肾上腺切除术的成本比腹腔镜肾上腺切除术高出 2.3 倍。本文献综述总结了目前现有的研究,并概述了机器人手术的应用、技术细节和手术结果。
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