What is Robotic Adrenal Surgery?

Robotic adrenal surgery (also called minimally invasive robotic adrenal surgery) is a surgical technique where the surgeon uses a "surgical robot" to assist in the dissection and removal of an adrenal gland. In general, the disadvantages far outweigh the advantages and robotic adrenal surgery is typically perfomed by surgeons who use the robot for other operations (like the prostate) and then adapt the technique for adrenal operations. We know of none of the world's experts at adrenal surgery who perform robotic adrenal surgery routinely.

The Robotic (robot-assisted) adrenalectomy approach is similar to laparoscopic trans-abdominal adrenalectomy (LTA) operation discussed as number 2 on the "8 Types of Adrenal Surgery" page except in the LTA, the surgeon holds the instruments in his hands, and in the robot-assisted operation, the instruments are held by a machine (the "robot") while the surgeon sits across the room manipulating the robotic hands on a TV screen. In BOTH the robotic adrenalectomy and the laparoscopic adrenalectomy, the operation is performed through the front of the abdomen with the instruments needing to work around and past all of the abdominal organs (bowel, stomach, spleen, liver, pancreas, etc) to get to the adrenal gland which is in the back behind all abdominal organs. In almost every case we know of, the reason a surgeon would use the robot due to inexperience with adrenal surgery, and not having performed enough minimally invasive adrenal operations; i.e. the Mini Back Scope Adrenalectomy (MBSA).

Why should laparoscopic and robotic (through the belly) adrenalectomy be avoided? Read more on our adrenal surgery blog

Does the Carling Adrenal Center Perform Robotic Adrenal Surgery?

Dr. Carling is the busiest adrenal surgeon in America, and while he was the Chief of Endocrine Surgery at Yale University he had the opportunity to help develop and evaluate robotic adrenal surgery. It became clear, however, after performing quite a few, that this operative approach to the adrenal glands is not nearly as good as the Mini Back Scope Adrenalectomy (MBSA). Thus, Dr. Carling and all of Yale Surgery abandoned robotic adrenal surgery in about 2010 and virtually every other adrenal surgery expert worldwide has followed suit, coming to the same conclusions. Of all the highest-volume minimally invasive adrenal surgeons in the world, not a single one uses a robot-assisted approach.

There are several problems with robotic adrenal surgery. This technique leads to significant increased operative time and expense of the operation without any added benefit. It generally takes about an hour just to get the robot all set up--and the patient is under general anesthesia during this time, yet the operation hasn't even begun. It is well-known that the length of time under general anesthesia correlates directly with increased risk of nausea, vomiting, and other complications of anesthesia. Using the robot is associated with larger endoscopic incisions (scars) which cause more postoperative pain, longer hospital stays, longer time until the the patients can return to normal activities and work when compared to theMini Back Scope Adrenalectomy (MBSA). The differences are huge.

Another problem with the robot-assisted adrenal surgery technique is that the surgeon can't see things very well. Since the adrenal gland is in the back behind all other abdominal organ, the instruments and the scope (camera) must go through the front of the abdomen past all of the organs. Thus during the operation the bowel, spleen, liver, and the pancreas have to be dissected with the potential for injury. Moreover, intra-abdominal adhesions (scars) may have formed from previous operations such as bariatric surgery (gastric band, sleeve gastrectomy, gastric bypass), gallbladder surgery (cholecystectomy), liver surgery, stomach surgery, bowel surgery of any kind (colectomy, appendectomy, etc) or any previous kind of gynecological operations (C-section, hysterectomy, etc). The robot-assisted adrenalectomy uses an intraabdominal approach and thus have to deal with these adhesions which can lead to injury and complications during the dissection. In fact, robot-assisted adrenalectomy means that the patient is at risk of developing future intra-abdominal abdominal adhesions, which can lead to problems with small bowel obstruction, a fairly common complication of robot-assisted surgical techniques.

For these reasons, we do not endorse robot-assisted adrenal surgery. If your surgeon suggests using a robot to remove your adrenal gland, you should seriously consider other options and consult with a surgeon with more experience in adrenal surgery. To be clear, we believe using the robot for adrenal surgery is a gimmick. And once more, we know all the world's top adrenal surgeons, and all of them abandoned robotic adrenal surgery over a decade ago. There has never been a publication in a surgical journal that shows using the robot is superior to any other adrenal operation except the open operation which is a 1940's technology and should never be done unless the tumor is a cancer (rare). The opposite is true, however, with every expert worldwide saying robotic adrenal surgery is rarely, if ever, the best choice for any patient.

It is possible that robotic surgical systems in the future will become significantly better, more minimalistic, less expensive and cumbersome to use without the current potential increased harm to the patient. The surgeons of the Carling Adrenal Center are always monitoring the development of robotic surgical systems carefully. However, at this time, we do not endorse robot-assisted adrenal surgery.

Why Does My Surgeon Want to Perform Robotic Adrenal Surgery on Me?

In almost every case we know of, the reason a surgeon wants to use a robot is because they are a urologist who performs robotic prostate surgery. But in our opinion, the number one reason a surgeon would use this technique is due to inexperience with adrenal surgery, and not having performed enough minimally invasive adrenal operations; Mini Back Scope Adrenalectomy (MBSA). You should seek the advice of an expert--none of the world's top adrenal surgeons are urologists. Yes, we understand that using the robot is now the best way to perform PROSTATE surgery, and a few other operations, but because the adrenal gland is located in the patient's back, an operation that goes through the back and not through the front of the abdomen is a better choice for almost all patients.

Why should laparoscopic and robotic (through the belly) adrenalectomy be avoided? Read more on our adrenal surgery blog

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What You Need to Know in One Sentence

If you need adrenal surgery, the best operation for almost everybody is 1) a minimally invasive SCOPE operation, 2) the scopes go through the patient's lower BACK and not through the patients front abdomen... a Mini Back Scope Adrenalectomy (MBSA) and 3) NOT a robot-assisted adrenalectomy.

If Not the Robot, What Operation Should Most People Have?

Our center, as well as all experts worldwide that we know of believe that the "Mini Back Scope Adrenalectomy (MBSA) is the preferred surgical approach for at least 95% of patients with adrenal tumors. High-volume, experienced adrenal surgeons do a better, safer, fasteR and less expensive adrenal operation than surgeons performing robot-assisted adrenalectomy.

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Patients needing adrenal surgery travel from all over the world to have adrenal surgery with Dr. Carling, the most experienced adrenal surgeon. This page discusses how you can have your adrenal operation at the Carling Adrenal Center with Dr. Carling himself.

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