Background:Minimally invasive surgery (MIS) for adrenal glands is becoming increasingly developed worldwide and robotic surgery has advanced significantly. Although there are still concerns about the generalization of outcomes and the cost burden, the robotic platform shows several advantages in overcoming some laparoscopic shortcomings.Materials and Methods:A systematic review and meta-analysis were conducted using the PubMed, MEDLINE and Cochrane library databases of published articles comparing RA and LA up to January 2024. The evaluated endpoints were technical and post-operative outcomes. Dichotomous data were calculated using the odds ratio (OR), while continuous data were analyzed usingmean difference (MD) with a 95% confidence interval (95% CI). A random-effects model (REM) was applied.Results:By the inclusion of 28 studies, the meta-analysis revealed no statistically significant difference in the rates of intraoperative RBC transfusion, 30-day mortality, intraoperative and overall postoperative complications, re-admission, R1 resection margin and operating time in the RA group compared with the LA. However, the overall cost of hospitalization was significantly higher in the RA group than in the LA group, [MD USD 4101.32, (95% CI 3894.85, 4307.79)p< 0.00001]. With respect to the mean intraoperative blood loss, conversion to open surgery rate, time to first flatus and length of hospital stay, the RA group showed slightly statistically significant lower rates than the laparoscopic approach.Conclusions:To our knowledge, this is the largest and most recent meta-analysis that makes these comparisons. RA can be considered safe, feasible and comparable to LA in terms of the intraoperative and post-operative outcomes. In the near future, RA could represent a promising complementary approachto LA for benign and small malignant adrenal masses, particularly in high-volume referral centers specializing in robotic surgery. However, further studies are needed to confirm these findings.
背景：肾上腺微创手术在全球范围内日益发展，机器人手术技术也取得了显著进步。尽管对结果普适性和成本负担仍存疑虑，但机器人平台在克服某些腹腔镜手术缺陷方面展现出多项优势。 材料与方法：通过检索截至2024年1月PubMed、MEDLINE及Cochrane图书馆数据库中比较机器人肾上腺切除术（RA）与腹腔镜肾上腺切除术（LA）的已发表文献，进行系统综述与荟萃分析。评估终点包括技术指标与术后结局。二分类数据采用比值比（OR）计算，连续数据采用均值差（MD）分析，均以95%置信区间（95% CI）表示，并应用随机效应模型（REM）。 结果：纳入28项研究的荟萃分析显示，与LA组相比，RA组在术中红细胞输注率、30天死亡率、术中及总体术后并发症发生率、再入院率、R1切除边缘阳性率及手术时间方面均无统计学显著差异。然而，RA组住院总成本显著高于LA组[MD 4101.32美元，（95% CI 3894.85，4307.79），p<0.00001]。在平均术中失血量、中转开腹率、首次排气时间及住院时长方面，RA组较腹腔镜组呈现轻微统计学显著优势。 结论：据我们所知，这是目前规模最大且最新的相关比较荟萃分析。就术中与术后结局而言，RA可被视为安全可行且与LA效果相当的技术。近期内，对于良性及小型恶性肾上腺肿瘤，特别是在专注于机器人手术的高容量转诊中心，RA有望成为LA的重要补充术式。但尚需进一步研究验证这些发现。
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