A. Lucy1, E. Malone1, J. Richman1, J. Owen1, J. R. Porterfield1 1University Of Alabama at Birmingham,Surgery,Birmingham, Alabama, USA
Introduction: Over the last decade, robotic adrenalectomy has been increasingly used for surgical management of adrenal masses. The da Vinci Xi robot was introduced in 2014 as a more versatile upgrade to their Si robot with the goal of promoting OR efficiency and multi-quadrant access. The specific benefits of the Xi robot have only been addressed in a limited number of specialties and procedures. The aim of this study was to compare the outcomes of the Xi vs. the Si system for robotic adrenalectomy in a high-volume center.
Methods: All patients at a single institution undergoing adrenalectomy between June 2008 and May 2018 were captured prospectively (n=515). We excluded patients who had an adrenalectomy by a non-robotic approach and who were <18 years old (n=212). Demographic, clinical, pathological, and operative variables were collected from electronic medical records. An adjusted negative binomial regression model was used to examine the change in total operating room time by robot type adjusting for all covariates significantly associated with room time in bivariate tests. These included diabetes, facility (main hospital vs. outpatient surgery center), robot type, and final pathology. Chi-square or Fisher's Exact Tests and t-tests were used to examine differences in categorical and continuous variables by robot type.
Results: Robot type was documented for 99% of 212 cases (n=209). There were no significant differences in patient demographics or preoperative comorbidities by the robot type. Median total room time using the Xi was 215 minutes (IQR: 190-254) vs. 235 (IQR 203-279) for the Si system (p=0.03). Other perioperative and pathological variables were similar. In adjusted models, total room time was 11% longer for diabetic patients vs. non-diabetics (IRR 1.11, 95% CI: 1.03-1.20), procedures done at our outpatient surgery center were 22% shorter vs. our main facility (IRR 0.78, 95% CI 0.68-0.89), and Xi robot procedures were 9% shorter than those done with the Si robot (IRR 0.91, 95% CI 0.83-0.99).
Conclusion: In adjusted analyses, the Xi robot has shorter adrenalectomy times compared to the Si robot. We attribute this decrease in operative time to the improved instrumentation, ease and efficiency in docking and patient positioning. More multi-institutional studies with larger groups of patients are needed to document the effect of advancing technology and carefully track and publish outcomes.