Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Society of Junior Doctors, Athens, Greece.
Society of Junior Doctors, Athens, Greece; Aristotle University of Thessaloniki, Medical School, Thessaloniki, Greece.
Int J Surg. 2017 Feb;38:95-104. doi: 10.1016/j.ijsu.2016.12.118. Epub 2016 Dec 30.
The benefit of robotic adrenalectomy (RA) compared to laparoscopic adrenalectomy (LA) is still debatable. The purpose of this paper was to systematically review and synthesize all available evidence comparing RA to LA so as to evaluate which procedure provides superior clinical outcomes.
A systematic literature search of PubMed and Scopus databases was performed with respect to the PRISMA statement (end-of-search date: January 31, 2016). Data on perioperative variables were extracted by three independent reviewers. Data were pooled using a random-effects model.
Twenty-seven studies were included in this review (13 comparative and 14 non-comparative). Overall, 1162 patients underwent adrenalectomy (747 treated with RA and 415 with LA). There was no significant difference between the robotic and the laparoscopic groups for intraoperative complications (OR: 1.20; 95%CI, 0.33-4.38), postoperative complications (OR: 0.69; 95% CI, 0.36-1.31), mortality (OR: 0.42; 95%CI, 0.07-2.72), conversion to laparotomy (OR: 0.51; 95%CI, 0.21-1.23), conversion to laparotomy or laparoscopy (OR: 0.73; 95%CI, 0.32-1.69) and blood loss (WMD: -9.78; 95%, -22.10 to 2.53). For patients treated with RA, there was a significantly shorter hospital stay (WMD: -0.40; 95% CI, -0.64 to -0.17) and a significantly longer operating time (WMD: 15.60; 95%CI, 2.12 to 29.08).
Robotic adrenalectomy is a safe and feasible procedure with similar clinical outcomes as the laparoscopic approach in selected patient populations. High quality RCTs as well as uniform and detailed reporting of outcomes are needed to determine the role and cost-effectiveness of robotic adrenal surgery in the years to come.
与腹腔镜肾上腺切除术（LA）相比，机器人肾上腺切除术（RA）的优势仍存在争议。本文旨在通过系统回顾和综合分析所有现有证据，评估哪种手术方式能提供更好的临床效果。
根据 PRISMA 声明，对 PubMed 和 Scopus 数据库进行了系统文献检索（检索截止日期：2016 年 1 月 31 日）。由三位独立评审员提取围手术期变量数据。采用随机效应模型对数据进行汇总。
本综述纳入了 27 项研究（13 项为对比研究，14 项为非对比研究）。共有 1162 名患者接受了肾上腺切除术（747 例接受 RA 治疗，415 例接受 LA 治疗）。机器人组和腹腔镜组的术中并发症（OR：1.20；95%CI，0.33-4.38）、术后并发症（OR：0.69；95%CI，0.36-1.31）、死亡率（OR：0.42；95%CI，0.07-2.72）、中转开腹（OR：0.51；95%CI，0.21-1.23）、中转开腹或腹腔镜（OR：0.73；95%CI，0.32-1.69）和出血量（WMD：-9.78；95%，-22.10 至 2.53）无显著差异。接受 RA 治疗的患者，其住院时间显著缩短（WMD：-0.40；95%CI，-0.64 至-0.17），手术时间显著延长（WMD：15.60；95%CI，2.12 至 29.08）。
在选择的患者人群中，RA 是一种安全可行的手术方式，其临床效果与 LA 相似。需要高质量的 RCT 以及对结果的统一和详细报告，以确定在未来几年中机器人肾上腺手术的作用和成本效益。
