PMID- 30077398 OWN - NLM STAT- MEDLINE DCOM- 20191209 LR - 20201215 IS - 1873-7560 (Electronic) IS - 0302-2838 (Linking) VI - 75 IP - 5 DP - 2019 May TI - Robot-assisted Partial Adrenalectomy for the Treatment of Conn's Syndrome: Surgical Technique, and Perioperative and Functional Outcomes. PG - 811-816 LID - S0302-2838(18)30552-9 [pii] LID - 10.1016/j.eururo.2018.07.030 [doi] AB - BACKGROUND: In the era of minimally invasive surgery, partial adrenalectomy has certainly been underused. We aimed to report surgical technique and perioperative, pathologic, and early functional outcomes of a two-center robot-assisted partial adrenalectomy (RAPA) series. OBJECTIVE: To detail surgical technique of RAPA for unilateral aldosterone-producing adenoma (UAPA), and to report perioperative and 1-yr functional outcomes. DESIGN, SETTING, AND PARTICIPANTS: Data of 10 consecutive patients who underwent RAPA for UAPA at two centers from June 2014 to April 2017 were prospectively collected and reported. SURGICAL PROCEDURE: RAPA was performed using a standardized technique with the da Vinci Si in a three-arm configuration. MEASUREMENTS: Baseline and perioperative data were reported. One-year functional outcomes were assessed according to primary aldosteronism surgery outcome guidelines. A descriptive statistical analysis was performed. RESULTS AND LIMITATIONS: All cases were completed robotically. Median nodule size was 18mm (interquartile range [IQR] 16-20). Intraoperative blood loss was negligible. A single (10%) postoperative Clavien grade 2 complication occurred. Median hospital stay was 3 d (IQR 2-3). Patients became normotensive immediately after surgery (median pre- and postoperative blood pressure: 150/90 and 120/70mmHg, respectively). At both 3-mo and 1-yr functional evaluation, all patients achieved biochemical success (aldosterone level, plasmatic renin activity, and aldosterone-renin ratio within normal range). Complete clinical success was achieved in nine patients, but one required low-dose amlodipine at 6-mo evaluation. At a median follow-up of 30.5 mo (IQR 19-42), neither symptoms nor imaging recurrence was observed. CONCLUSIONS: We demonstrated feasibility and safety of RAPA for UAPA; this technique had very low risk of complications and excellent functional results. Increased availability of robotic platform and increasing robotic skills among urologists make RAPA a treatment option with potential for widespread use in urologic community. PATIENT SUMMARY: Robot-assisted partial adrenalectomy is a safe, feasible, and minimally invasive surgical approach. Promising perioperative and functional outcomes suggest an increasing adoption of this technique in the near future. CI - Copyright (c) 2018 European Association of Urology. Published by Elsevier B.V. All rights reserved. FAU - Simone, Giuseppe AU - Simone G AD - Department of Urology, "Regina Elena" National Cancer Institute, Rome, Italy. Electronic address: puldet@gmail.com. FAU - Anceschi, Umberto AU - Anceschi U AD - Department of Urology, "Regina Elena" National Cancer Institute, Rome, Italy. FAU - Tuderti, Gabriele AU - Tuderti G AD - Department of Urology, "Regina Elena" National Cancer Institute, Rome, Italy. FAU - Misuraca, Leonardo AU - Misuraca L AD - Department of Urology, "Regina Elena" National Cancer Institute, Rome, Italy. FAU - Celia, Antonio AU - Celia A AD - Department of Urology, San Bassiano Hospital, Bassano Del Grappa, Italy. FAU - De Concilio, Bernardino AU - De Concilio B AD - Department of Urology, San Bassiano Hospital, Bassano Del Grappa, Italy. FAU - Costantini, Manuela AU - Costantini M AD - Department of Urology, "Regina Elena" National Cancer Institute, Rome, Italy. FAU - Stigliano, Antonio AU - Stigliano A AD - Department of Clinical and Molecular Medicine, Sant'Andrea Hospital, Rome, Italy. FAU - Minisola, Francesco AU - Minisola F AD - Department of Urology, "Regina Elena" National Cancer Institute, Rome, Italy. FAU - Ferriero, Mariaconsiglia AU - Ferriero M AD - Department of Urology, "Regina Elena" National Cancer Institute, Rome, Italy. FAU - Guaglianone, Salvatore AU - Guaglianone S AD - Department of Urology, "Regina Elena" National Cancer Institute, Rome, Italy. FAU - Gallucci, Michele AU - Gallucci M AD - Department of Urology, "Regina Elena" National Cancer Institute, Rome, Italy. LA - eng PT - Journal Article PT - Multicenter Study DEP - 20180801 PL - Switzerland TA - Eur Urol JT - European urology JID - 7512719 RN - 4964P6T9RB (Aldosterone) RN - EC 3.4.23.15 (Renin) SB - IM CIN - Eur Urol. 2019 Nov;76(5):e142-e143. PMID: 31427123 CIN - Eur Urol. 2019 Nov;76(5):e144-e145. PMID: 31526607 CIN - Eur Urol. 2020 Aug;78(2):e83-e84. PMID: 32461074 CIN - Eur Urol. 2020 Aug;78(2):e85-e86. PMID: 32507336 MH - Adrenal Cortex Neoplasms/complications/physiopathology/*surgery MH - Adrenalectomy/*methods MH - Adrenocortical Adenoma/complications/physiopathology/*surgery MH - Adult MH - Aldosterone/blood MH - Blood Pressure MH - Female MH - Humans MH - Hyperaldosteronism/etiology/physiopathology/*surgery MH - Male MH - Middle Aged MH - Renin/blood MH - *Robotic Surgical Procedures MH - Treatment Outcome OTO - NOTNLM OT - Adrenal adenoma OT - Adrenal sparing OT - Aldosterone OT - Conn's syndrome OT - Partial adrenalectomy OT - Robotic surgery EDAT- 2018/08/06 06:00 MHDA- 2019/12/18 06:00 CRDT- 2018/08/06 06:00 PHST- 2018/04/26 00:00 [received] PHST- 2018/07/19 00:00 [accepted] PHST- 2018/08/06 06:00 [pubmed] PHST- 2019/12/18 06:00 [medline] PHST- 2018/08/06 06:00 [entrez] AID - S0302-2838(18)30552-9 [pii] AID - 10.1016/j.eururo.2018.07.030 [doi] PST - ppublish SO - Eur Urol. 2019 May;75(5):811-816. doi: 10.1016/j.eururo.2018.07.030. Epub 2018 Aug 1.