Innovation in endocrine surgery: robotic versus laparoscopic adrenalectomy. Meta-analysis and systematic literature review
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Antonino Agrusa1, Giorgio Romano1, Giuseppe Navarra2, Giovanni Conzo3, Gianni Pantuso4, Giuseppe Di Buono1, Roberto Citarrella5, Massimo Galia6, Attilio Lo Monte1, Gaspare Cucinella7 and Gaspare Gulotta1
1Department of General Surgery, Urgency and Organ Transplantation, University of Palermo, Palermo, Italy
2Department of Human Pathology University Hospital of Messina, Messina, Italy
3Department of Anesthesiologic, Surgical and Emergency Sciences, Division of General and Oncologic Surgery, School of Medicine, Second University of Naples, Naples, Italy
4Department of Surgery and Oncology, University of Palermo, Palermo, Italy
5Department of Experimental Biomedicine and Clinical Neurosciences, University of Palermo, Palermo, Italy
6Section of Radiology - Di.Bi.Me.F., University of Palermo, Palermo, Italy
7Department of Obstetrics and Gynecology, University of Palermo, Palermo, Italy
Antonino Agrusa, email: email@example.com
Keywords: laparoscopic adrenalectomy, robotic adrenalectomy, laparoscopic surgery, robotic surgery, adrenal surgery
Received: July 18, 2017 Accepted: September 23, 2017 Published: October 19, 2017
Several studies in the last years demonstrated the better surgical outcome of laparoscopic approach to adrenal gland. Laparoscopic surgery is more difficult to learn and requires different psychomotor skills than open surgery, especially with regard to complex maneuvers requiring precision and dexterity. The development of robotic platform with three-dimensional vision and increased degrees of freedom of the surgical instruments has the aim to overcome these problems. We performed a systematic literature review with meta-analysis to evaluate preoperative data and surgical outcomes of robotic adrenalectomy compared with laparoscopic technique. In September 2016 we performed a systematic literature review using the Pubmed, Scopus and ISI web of knowledge database with search term “robotic adrenalectomy”. We identified 13 studies with eligible criteria that compared surgical outcomes. This present systematic review with meta-analysis includes 798 patients: 379 underwent to robotic adrenalectomy (cases group) and 419 to laparoscopic adrenalectomy (controls group). There were no significant differences between the two groups of patients respect to age, gender, laterality and tumor size. BMI instead was significant lower in the robotic group. In this group we found also patients with higher incidence of previous abdominal surgery. The results from operative time demonstrated lower operative time for laparoscopic group but there were no significant differences with robotic group. Robotic adrenalectomy showed a significant lower blood loss. Robotic adrenalectomy is a safe and feasible technique with reduced blood loss and shorter hospital stay than laparoscopic adrenalectomy. Laparoscopic approach seems to be a more rapid technique when comparing to robotic technique, although recent studies demonstrate a significant operative time reduction in robotic group with the learning curve improvement and the development of new surgical technology.
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