Journal
INTERNATIONAL JOURNAL OF SURGERY
Volume 105, Issue -, Pages -Publisher
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1016/j.ijsu.2022.106853
Keywords
Robot-assisted adrenalectomy; Laparoscopic adrenalectomy; Adrenal tumour
Categories
Funding
- Sichuan Province Science and Technology Planning Project [2020YFS0320]
- Sichuan Provincial Science and Technology Department Project Support Project [20PJ305]
- Nanchong City School Science and Technology Cooperation Project [NSMC20170457]
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This study compared the safety and effectiveness of robot-assisted adrenalectomy (RA) and laparoscopic adrenalectomy (LA). The results showed that the robotic technique was superior to laparoscopy in terms of reducing blood loss, shortening the length of stay, and decreasing the conversion to open surgery. Complications and readmissions were comparable between the two surgical modalities. The retroperitoneal route robotic technique took longer, while the mixed surgical modality required less time. For pheochromocytoma, RA was superior to LA in terms of length of stay, with no difference in other indicators.
Objective: To compare the safety and effectiveness of robot-assisted adrenalectomy (RA) and laparoscopic adrenalectomy (LA). Methods: We performed a systematic review and cumulative meta-analysis of the primary outcomes of interest according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and AMSTAR (Assessing the Methodological Quality of Systematic Reviews) Guidelines. Five databases, including Medline, PubMed, Cochrane Library, Scopus, and Web of Science, were systematically searched. The search timeframe was set from the creation of the database to December 2021. Results: There were 26 studies including 2985 patients. Our study found that the robotic technique was superior to conventional laparoscopy for estimated blood loss (WMD = -18.25, 95% CI [-27.85, -8.65], P < 0.01), length of stay (WMD = -0.45, 95% CI [-0.57, -0.33], P < 0.01), and conversion to open (OR = 0.31, 95% CI [0.12, 0.78], P = 0.01), while complications and readmissions were comparable. Interestingly, there was no difference in operative time between the two surgical modalities, but subgroup analysis found that the retroperitoneal route robotic technique took longer (WMD = 14.64, 95% CI [0.04, 29.24], P < 0.05), whereas the study of the mixed surgical modality (RA versus LA with mixed transabdominal and retroperitoneal surgical routes) found that the robot required less time (WMD = -12.29, 95% CI [-22.86, -1.72], P < 0.05). For pheochromocytoma, RA was superior to LA in terms of length of stay (WMD = -0.49, 95% CI [-0.83, -0.15], P < 0.01), with no difference in other indicators. Conclusion: robotic-assisted adrenalectomy is a superior technique to conventional laparoscopy in managing adrenal tumors, even in the case of a specific adrenal tumor - pheochromocytoma.
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