Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA.
Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA; Urology Unit, Second University of Naples, Naples, Italy.
Eur Urol. 2014 Jun;65(6):1154-61. doi: 10.1016/j.eururo.2013.09.021. Epub 2013 Sep 20.
Over the last decade, robot-assisted adrenalectomy has been included in the surgical armamentarium for the management of adrenal masses.
To critically analyze the available evidence of studies comparing laparoscopic and robotic adrenalectomy.
A systematic literature review was performed in August 2013 using PubMed, Scopus, and Web of Science electronic search engines. Article selection proceeded according to the search strategy based on Preferred Reporting Items for Systematic Reviews and Meta-analysis criteria.
Nine studies were selected for the analysis including 600 patients who underwent minimally invasive adrenalectomy (277 robot assisted and 323 laparoscopic). Only one of the studies was a randomized clinical trial (RCT) but of low quality according to the Jadad scale. However, the methodological quality of included nonrandomized studies was relatively high. Body mass index was higher for the laparoscopic group (weighted mean difference [WMD]: -2.37; 95% confidence interval [CI], - 3.01 to -1.74; p<0.00001). A transperitoneal approach was mostly used for both techniques (72.5% of robotic cases and 75.5% of laparoscopic cases; p=0.27). There was no significant difference between the two groups in terms of conversion rate (odds ratio [OR]: 0.82; 95% CI, 0.39-1.75; p=0.61) and operative time (WMD: 5.88; 95% CI, -6.02 to 17.79; p=0.33). There was a significantly longer hospital stay in the conventional laparoscopic group (WMD: -0.43; 95% CI, -0.56 to -0.30; p<0.00001), as well as a higher estimated blood loss (WMD: -18.21; 95% CI, -29.11 to -7.32; p=0.001). There was also no statistically significant difference in terms of postoperative complication rate (OR: 0.04; 95% CI, -0.07 to -0.00; p=0.05) between groups. Most of the postoperative complications were minor (80% for the robotic group and 68% for the conventional laparoscopic group). Limitations of the present analysis are the limited sample size and including only one low-quality RCT.
Robot-assisted adrenalectomy can be performed safely and effectively with operative time and conversion rates similar to laparoscopic adrenalectomy. In addition, it can provide potential advantages of a shorter hospital stay, less blood loss, and lower occurrence of postoperative complications. These findings seem to support the use of robotics for the minimally invasive surgical management of adrenal masses.
在过去十年中，机器人辅助肾上腺切除术已被纳入肾上腺肿块治疗的手术手段中。
批判性分析比较腹腔镜和机器人肾上腺切除术的现有研究证据。
2013 年 8 月，使用 PubMed、Scopus 和 Web of Science 电子搜索引擎进行了系统文献综述。根据基于系统评价和荟萃分析首选报告项目的搜索策略进行文章选择。
分析中选择了 9 项研究，包括 600 例接受微创肾上腺切除术（277 例机器人辅助和 323 例腹腔镜）的患者。只有一项研究是随机临床试验（RCT），但根据 Jadad 量表，质量较低。然而，纳入的非随机研究的方法学质量相对较高。腹腔镜组的体重指数（BMI）较高（加权均数差 [WMD]：-2.37；95%置信区间 [CI]，-3.01 至-1.74；p<0.00001）。两种技术大多采用经腹腔途径（机器人手术的 72.5%和腹腔镜手术的 75.5%；p=0.27）。两组之间的转化率（优势比 [OR]：0.82；95%CI，0.39-1.75；p=0.61）和手术时间（WMD：5.88；95%CI，-6.02 至 17.79；p=0.33）无显著差异。传统腹腔镜组的住院时间明显延长（WMD：-0.43；95%CI，-0.56 至-0.30；p<0.00001），估计出血量也较高（WMD：-18.21；95%CI，-29.11 至-7.32；p=0.001）。两组之间术后并发症发生率（OR：0.04；95%CI，-0.07 至-0.00；p=0.05）也无统计学差异。大多数术后并发症为轻微（机器人组 80%，传统腹腔镜组 68%）。本分析的局限性是样本量有限，仅包括一项低质量 RCT。
机器人辅助肾上腺切除术可以安全有效地进行，手术时间和转化率与腹腔镜肾上腺切除术相似。此外，它还可以提供潜在的优势，如较短的住院时间、较少的出血量和较低的术后并发症发生率。这些发现似乎支持将机器人技术用于微创治疗肾上腺肿块。
