Geisinger Medical Center, 100 N. Academy Avenue, MC 21-69, Danville, PA, 17822, USA.
J Robot Surg. 2019 Feb;13(1):69-75. doi: 10.1007/s11701-018-0808-3. Epub 2018 Apr 25.
Laparoscopic adrenalectomy (LA) has become the standard treatment of adrenal lesions. Recently, robotic-assisted adrenalectomy (RA) has become an option, however, short-term outcomes for RA have not been well studied and benefits over LA are debatable. The aim of this study was to explore differences in short-term outcomes between LA and RA using the national inpatient sample (NIS) database.
Patient data were collected from the NIS. All patients undergoing LA or RA from January 2009 to December 2012 were included. Univariate analysis and propensity matching were performed to look for differences between the groups.
A total of 1006 patients (66.4% in LA group and 33.6% in RA group) were identified. Patient age group, gender, race, risk of mortality, severity of illness or indication for adrenalectomy did not differ significantly between the LA or RA cohorts. Insurance type predicted procedure type (45% of medicare patients underwent RA versus 29% of patients with private insurance, p < 0.0001). Patients living in the highest income areas were more likely to receive the laparoscopic approach (31.7 versus 17.4%, p < 0.0001). Hospital volume, bed size and teaching status of the hospital were not significant factors in the decision of RA versus LA. There was no difference in complication and conversion rates between RA versus LA. The mean length of stay was shorter in the RA group (2.2 versus 1.9 days, p = 0.03). Total charges were higher in the RA group ($42,659 versus $33,748, p < 0.0001). There was a significant trend towards more adrenalectomies being performed robotic assisted by year. Only 22% of adrenalectomies were performed robotic-assisted in 2009 compared with 48% in 2012.
The overall benefit for RA remains small and higher total charges for RA may currently outweigh the benefits. These findings may change as more cases are performed robotically assisted and robotic technology improves.
腹腔镜肾上腺切除术（LA）已成为治疗肾上腺病变的标准方法。最近，机器人辅助肾上腺切除术（RA）已成为一种选择，然而，RA 的短期疗效尚未得到很好的研究，其相对于 LA 的优势仍存在争议。本研究旨在利用国家住院患者样本（NIS）数据库探讨 LA 和 RA 之间短期疗效的差异。
从 NIS 中收集患者数据。纳入 2009 年 1 月至 2012 年 12 月期间接受 LA 或 RA 的所有患者。进行单变量分析和倾向匹配以寻找两组之间的差异。
共纳入 1006 例患者（LA 组 66.4%，RA 组 33.6%）。LA 或 RA 组患者的年龄组、性别、种族、死亡率风险、疾病严重程度或肾上腺切除术指征无显著差异。保险类型预测手术类型（45%的医疗保险患者接受 RA，而私人保险患者为 29%，p<0.0001）。收入最高地区的患者更倾向于接受腹腔镜手术（31.7%比 17.4%，p<0.0001）。医院规模、床位数和医院教学状况并非决定 RA 与 LA 的重要因素。RA 与 LA 之间的并发症和中转率无差异。RA 组的平均住院时间较短（2.2 天比 1.9 天，p=0.03）。RA 组的总费用较高（$42659 比 $33748，p<0.0001）。机器人辅助肾上腺切除术的数量呈逐年增加趋势。2009 年仅有 22%的肾上腺切除术采用机器人辅助，而 2012 年则达到 48%。
RA 的总体获益仍然较小，RA 的总费用较高可能超过其获益。随着更多的病例采用机器人辅助进行并随着机器人技术的进步，这些发现可能会发生变化。
