Tang Kun, Li Heng, Xia Ding, Yu Gan, Guo Xiaolin, Guan Wei, Xu Hua, Ye Zhangqun
Department of Urology and Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology , Wuhan, China .
J Laparoendosc Adv Surg Tech A. 2015 Mar;25(3):187-95. doi: 10.1089/lap.2014.0431.
More recently, robot-assisted adrenalectomy (RA) has emerged as an attractive alternative to laparoscopic adrenalectomy (LA), and many studies have shown the feasibility and safety of RA. However, the short- and long-term outcomes of RA versus LA have not been adequately assessed, and the advantage over the laparoscopic approach has not been demonstrated. The aim of this study was to compare the outcomes of RA versus LA by means of a systematic review and meta-analysis of the available literature in the early experience.
A systematic search of PubMed, SCI/SSCI, CNKI, and the Cochrane Library was performed to identify prospective randomized controlled trials and retrospective observational studies that compared RA and LA and were published between January 2006 to the end of December 2012. Outcomes of interest included demographic and clinical characteristics, perioperative variables, and complications. The meta-analysis was prepared in accordance with the Quality of Reporting of Meta-analyses (QUOROM) statement.
Eight trials (232 cases and 297 controls) assessing RA versus LA were considered suitable for meta-analysis, including six prospective and two retrospective studies. There was a significant trend to choose patients for the performance of RA who were associated with a lower body mass index (weighted mean difference [WMD]=-2.78 kg/m(2); 95% confidence interval [CI], -3.00 to -2.55; P<.001) and higher incidence of previous surgery (odds ratio=1.59; 95% CI, 0.99-2.54; P=.05). There were no significant differences between the two groups in any other of the demographic parameters. With regard to perioperative variables, although there was a significant difference in the operating time in favor of LA (WMD=17.52 minutes; 95% CI, 3.48-31.56; P=.01), patients having RA might benefit from significantly less blood loss (WMD=-19.00 mL; 95% CI, -34.58 to -3.41; P=.02) and shorter length of hospital stay (WMD=-0.35 day; 95% CI, -0.51 to -0.19; P<.001). There were no significant differences between RA and LA with regard to conversion rates and overall complications. Sensitivity analysis performed by two methods both showed a positive reversal in the operating time with the statistical significance removed compared with the original analysis.
In the early experience, our data suggest that RA, compared with LA, may be a safe and feasible option associated with less blood loss and shorter hospital stay when performed by experienced surgeons in selected patients.
最近，机器人辅助肾上腺切除术（RA）已成为腹腔镜肾上腺切除术（LA）的一种有吸引力的替代方法，许多研究已表明RA的可行性和安全性。然而，RA与LA的短期和长期结果尚未得到充分评估，其相对于腹腔镜手术方法的优势也未得到证实。本研究的目的是通过对早期经验中现有文献的系统评价和荟萃分析，比较RA与LA的结果。
对PubMed、SCI/SSCI、中国知网和考克兰图书馆进行系统检索，以确定2006年1月至2012年12月底发表的比较RA和LA的前瞻性随机对照试验和回顾性观察性研究。感兴趣的结果包括人口统计学和临床特征、围手术期变量及并发症。荟萃分析按照荟萃分析报告质量（QUOROM）声明编制。
八项评估RA与LA的试验（232例病例和297例对照）被认为适合进行荟萃分析，包括六项前瞻性研究和两项回顾性研究。在选择进行RA手术的患者方面存在显著趋势，这些患者的体重指数较低（加权平均差[WMD]=-2.78kg/m²；95%置信区间[CI]，-3.00至-2.55；P<0.001）且既往手术发生率较高（优势比=1.59；95%CI，0.99-2.54；P=0.05）。两组在任何其他人口统计学参数方面均无显著差异。关于围手术期变量，尽管手术时间存在显著差异，LA更具优势（WMD=17.52分钟；95%CI，3.48-31.56；P=0.01），但接受RA的患者可能因失血显著减少（WMD=-19.00mL；95%CI，-34.58至-3.41；P=0.02）和住院时间缩短（WMD=-0.35天；95%CI，-0.51至-0.19；P<0.001）而受益。RA与LA在转化率和总体并发症方面无显著差异。通过两种方法进行的敏感性分析均显示，与原始分析相比，手术时间出现正向反转且统计学意义消失。
在早期经验中，我们的数据表明，与LA相比，对于经过挑选的患者，由经验丰富的外科医生进行RA手术可能是一种安全可行的选择，且失血更少、住院时间更短。
