Top

Langenbeck's Archives of Surgery

Published in:

01-03-2020 | Adrenalectomy | Systematic Review and Meta-analyses

Comparing the efficacy and safety of laparoscopic and robotic adrenalectomy: a meta-analysis and trial sequential analysis

Authors: Konstantinos Perivoliotis, Ioannis Baloyiannis, Chamaidi Sarakatsianou, George Tzovaras

Published in: Langenbeck's Archives of Surgery | Issue 2/2020

Abstract

Purpose

A systematic literature review and a meta-analysis were designed and conducted, in order to provide an up-to-date comparison of the robotic (RA) and laparoscopic (LA) adrenalectomy in terms of perioperative efficacy and safety.

Methods

The present meta-analysis was completed in accordance with the guidelines provided by the PRISMA study group and the Cochrane Handbook for Systematic Reviews of Interventions. The electronic scholar databases (Medline, Web of Science, Scopus) were screened. For the reduction of type I errors, a trial sequential analysis (TSA) was performed.

Results

Overall, 21 studies and 2997 patients were included in this study. RA was associated with a significantly lower open conversion rate (OR: 1.79; 95%CI: 1.10, 2.92) and length of hospitalization (LOS WMD: 0.52; 95%CI: 0.2, 0.84). Marginal results regarding blood loss were recorded (WMD: 2.02; 95%CI: 0.0, 4.03). TSA could not validate the superiority of RA in open conversion rate and blood loss. LA and RA were similar in terms of operative duration (P = 0.18) and positive margin (P = 0.81), complications (P = 0.94) and mortality rate (P = 0.45).

Conclusions

Even though RA and LA were equivalent regarding perioperative safety, RA was associated with a favorable LOS.

Available only for authorised users

Gagner M, Lacroix A, Bolté E (1992) Laparoscopic adrenalectomy in Cushing’s syndrome and pheochromocytoma. N Engl J Med 327:1033–1033. https://doi.org/10.1056/NEJM199210013271417 CrossRefPubMed

Jacobsen N-EB, Campbell JB, Hobart MG (2003) Laparoscopic versus open adrenalectomy for surgical adrenal disease. Can J Urol 10:1995–1999PubMed

Hallfeldt KKJ, Mussack T, Trupka A, Hohenbleicher F, Schmidbauer S (2003) Laparoscopic lateral adrenalectomy versus open posterior adrenalectomy for the treatment of benign adrenal tumors. Surg Endosc 17:264–267. https://doi.org/10.1007/s00464-002-8810-1 CrossRefPubMed

Dudley NE, Harrison BJ (1999) Comparison of open posterior versus transperitoneal laparoscopic adrenalectomy. Br J Surg 86:656–660. https://doi.org/10.1046/j.1365-2168.1999.01110.x CrossRefPubMed

Chigot JP, Movschin M, el Bardissi M, Fercocq O, Paraskevas A (1998) Comparative study between laparoscopic and conventional adrenalectomy for pheochromocytomas. Ann Chir 52:346–349PubMed

Heger P, Probst P, Huttner FJ et al (2017) Evaluation of open and minimally invasive Adrenalectomy: a systematic review and network meta-analysis. World J Surg 41:2746–2757. https://doi.org/10.1007/s00268-017-4095-3 CrossRefPubMed

Constantinides VA, Christakis I, Touska P, Palazzo FF (2012) Systematic review and meta-analysis of retroperitoneoscopic versus laparoscopic adrenalectomy. Br J Surg 99:1639–1648. https://doi.org/10.1002/bjs.8921 CrossRefPubMed

Mpaili E, Moris D, Tsilimigras DI et al (2018) Laparoscopic versus open Adrenalectomy for localized/locally advanced primary adrenocortical carcinoma (ENSAT I–III) in adults: is margin-free resection the key surgical factor that dictates outcome? A review of the literature. J Laparoendosc Adv Surg Tech 28:408–414. https://doi.org/10.1089/lap.2017.0546 CrossRef

Zheng G-Y, Li H-Z, Deng J-H et al (2018) Open adrenalectomy versus laparoscopic adrenalectomy for adrenocortical carcinoma: a retrospective comparative study on short-term oncologic prognosis. Onco Targets Ther Volume 11:1625–1632. https://doi.org/10.2147/OTT.S157518 CrossRef

10.

Wu K, Liu Z, Liang J, Tang Y, Zou Z, Zhou C, Zhang F, Lu Y (2018) Laparoscopic versus open adrenalectomy for localized (stage 1/2) adrenocortical carcinoma: experience at a single, high-volumecenter. Surgery 164:1325–1329. https://doi.org/10.1016/j.surg.2018.07.026 CrossRefPubMed

11.

Ball MW, Hemal AK, Allaf ME (2017) International Consultation on Urological Diseases and European Association of Urology International Consultation on mMinimally Invasive Surgery in Urology: laparoscopic and robotic adrenalectomy. BJU Int 119:13–21. https://doi.org/10.1111/bju.13592 CrossRefPubMed

12.

Piazza L, Caragliano P, Scardilli M et al (1999) Laparoscopic robot-assisted right adrenalectomy and left ovariectomy (case reports). Chir Ital 51:465–466PubMed

13.

Marcus HJ, Hughes-Hallett A, Payne CJ et al (2017) Trends in the diffusion of robotic surgery: a retrospective observational study. Int J Med Robot:13. https://doi.org/10.1002/rcs.1870 CrossRef

14.

Calcatera NA, Hsiung-Wang C, Suss NR, Winchester DJ, Moo-Young TA, Prinz RA (2018) Minimally invasive adrenalectomy for adrenocortical carcinoma: five-year trends and predictors of conversion. World J Surg 42:473–481. https://doi.org/10.1007/s00268-017-4290-2 CrossRefPubMed

15.

Dickson PV, Alex GC, Grubbs EG, Jimenez C, Lee JE, Perrier ND (2013) Robotic-assisted retroperitoneoscopic adrenalectomy: making a good procedure even better. Am Surg 79:84–89PubMed

16.

Pineda-Solis K, Medina-Franco H, Heslin MJ et al (2013) Robotic versus laparoscopic adrenalectomy: a comparative study in a high-volume center. Surg Endosc 27:599–602. https://doi.org/10.1007/s00464-012-2496-9 CrossRefPubMed

17.

Brandao LF, Autorino R, Zargar H, Krishnan J, Laydner H, Akca O, Mir MC, Samarasekera D, Stein R, Kaouk J (2014) Robot-assisted laparoscopic adrenalectomy: step-by-step technique and comparative outcomes. Eur Urol 66:898–905. https://doi.org/10.1016/j.eururo.2014.04.003 CrossRefPubMed

18.

Colvin J, Krishnamurthy V, Jin J et al (2017) A comparison of robotic versus laparoscopic adrenalectomy in patients with primary hyperaldosteronism. Surg Laparosc Endosc Percutan Tech 27:391–393. https://doi.org/10.1097/SLE.0000000000000455 CrossRefPubMed

19.

Agcaoglu O, Aliyev S, Karabulut K, Mitchell J, Siperstein A, Berber E (2012) Robotic versus laparoscopic resection of large adrenal tumors. Ann Surg Oncol 19:2288–2294. https://doi.org/10.1245/s10434-012-2296-4 CrossRefPubMed

20.

Morino M, Beninca G, Giraudo G et al (2004) Robot-assisted vs laparoscopic adrenalectomy: a prospective randomized controlled trial. Surg Endosc 18:1742–1746. https://doi.org/10.1007/s00464-004-9046-z CrossRefPubMed

21.

You JY, Lee HY, Son GS, Lee JB, Bae JW, Kim HY (2013) Comparison of robotic adrenalectomy with traditional laparoscopic adrenalectomy with a lateral transperitoneal approach: a single-surgeon experience. Int J Med Robot 9:345–350. https://doi.org/10.1002/rcs.1497 CrossRefPubMed

22.

Raffaelli M, Brunaud L, De Crea C et al (2014) Synchronous bilateral adrenalectomy for Cushing’s syndrome: laparoscopic versus posterior retroperitoneoscopic versus robotic approach. World J Surg 38:709–715. https://doi.org/10.1007/s00268-013-2326-9 CrossRefPubMed

23.

Aliyev S, Karabulut K, Agcaoglu O, Wolf K, Mitchell J, Siperstein A, Berber E (2013) Robotic versus laparoscopic adrenalectomy for pheochromocytoma. Ann Surg Oncol 20:4190–4194. https://doi.org/10.1245/s10434-013-3134-z CrossRefPubMed

24.

Feng Z, Feng MP, Feng DP, Rice MJ, Solórzano CC (2018) A cost-conscious approach to robotic adrenalectomy. J Robot Surg 12:607–611. https://doi.org/10.1007/s11701-018-0782-9 CrossRefPubMed

25.

Pavan N, Autorino R, Lee H, Porpiglia F, Sun Y, Greco F, Jeff Chueh S, Han DH, Cindolo L, Ferro M, Chen X, Branco A, Fornara P, Liao CH, Miyajima A, Kyriazis I, Puglisi M, Fiori C, Yang B, Fei G, Altieri V, Jeong BC, Berardinelli F, Schips L, de Cobelli O, Chen Z, Haber GP, He Y, Oya M, Liatsikos E, Brandao L, Challacombe B, Kaouk J, Darweesh I (2016) Impact of novel techniques on minimally invasive adrenal surgery: trends and outcomes from a contemporary international large series in urology. World J Urol 34:1473–1479. https://doi.org/10.1007/s00345-016-1791-9 CrossRefPubMed

26.

Mishra K, Maurice MJ, Bukavina L, Abouassaly R (2019) Comparative efficacy of laparoscopic versus robotic adrenalectomy for adrenal malignancy. Urology 123:146–150. https://doi.org/10.1016/j.urology.2018.08.037 CrossRefPubMed

27.

Agrusa A, Romano G, Navarra G et al (2017) Innovation in endocrine surgery: robotic versus laparoscopic adrenalectomy. Meta-analysis and systematic literature review. Oncotarget 8:102392–102400. https://doi.org/10.18632/oncotarget.22059 CrossRefPubMedPubMedCentral

28.

Economopoulos KP, Mylonas KS, Stamou AA, Theocharidis V, Sergentanis TN, Psaltopoulou T, Richards ML (2017) Laparoscopic versus robotic adrenalectomy: a comprehensive meta-analysis. Int J Surg 38:95–104. https://doi.org/10.1016/j.ijsu.2016.12.118 CrossRefPubMed

29.

Samreen S, Fluck M, Hunsinger M, Wild J, Shabahang M, Blansfield JA (2019) Laparoscopic versus robotic adrenalectomy: a review of the national inpatient sample. J Robot Surg 13:69–75. https://doi.org/10.1007/s11701-018-0808-3 CrossRefPubMed

30.

Moher D, Liberati A, Tetzlaff J, Altman DG, PRISMA Group (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 6:e1000097. https://doi.org/10.1371/journal.pmed.1000097 CrossRefPubMedPubMedCentral

31.

Higgins J, Green S (2011) Cochrane handbook for systematic reviews of interventions version 5.1. 0 [updated March 2011]. In: cochrane Collab. https://training.cochrane.org/handbook

32.

Higgins JPT, Altman DG, Gøtzsche PC et al (2011) The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. BMJ 343:d5928CrossRefPubMedPubMedCentral

33.

Sterne JA, Hernán MA, Reeves BC, Savović J, Berkman ND, Viswanathan M, Henry D, Altman DG, Ansari MT, Boutron I, Carpenter JR, Chan AW, Churchill R, Deeks JJ, Hróbjartsson A, Kirkham J, Jüni P, Loke YK, Pigott TD, Ramsay CR, Regidor D, Rothstein HR, Sandhu L, Santaguida PL, Schünemann HJ, Shea B, Shrier I, Tugwell P, Turner L, Valentine JC, Waddington H, Waters E, Wells GA, Whiting PF, Higgins JP (2016) ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions. BMJ 355:i4919. https://doi.org/10.1136/bmj.i4919 CrossRefPubMedPubMedCentral

34.

McGuinness LA (2019) Robvis: an R package and web application for visualising risk-of-bias assessments. https://github.com/mcguinlu/robvis

35.

Valentine JC, Pigott TD, Rothstein HR (2010) How many studies do You need? J Educ Behav Stat 35:215–247. https://doi.org/10.3102/1076998609346961 CrossRef

36.

Hozo SP, Djulbegovic B, Hozo I (2005) Estimating the mean and variance from the median, range, and the size of a sample. BMC Med Res Methodol 5:13. https://doi.org/10.1186/1471-2288-5-13 CrossRefPubMedPubMedCentral

37.

Wan X, Wang W, Liu J, Tong T (2014) Estimating the sample mean and standard deviation from the sample size, median, range and/or interquartile range. BMC Med Res Methodol 14:135. https://doi.org/10.1186/1471-2288-14-135 CrossRefPubMedPubMedCentral

38.

Wetterslev J, Thorlund K, Brok J, Gluud C (2008) Trial sequential analysis may establish when firm evidence is reached in cumulative meta-analysis. J Clin Epidemiol 61:64–75. https://doi.org/10.1016/j.jclinepi.2007.03.013 CrossRefPubMed

39.

Asher KP, Gupta GN, Boris RS, Pinto PA, Linehan WM, Bratslavsky G (2011) Robot-assisted laparoscopic partial adrenalectomy for pheochromocytoma: the National Cancer Institute technique. Eur Urol 60:118–124. https://doi.org/10.1016/j.eururo.2011.03.046 CrossRefPubMedPubMedCentral

40.

Brunaud L, Ayav A, Zarnegar R et al (2008) Prospective evaluation of 100 robotic-assisted unilateral adrenalectomies. Surgery 144:995–1001; discussion 1001. https://doi.org/10.1016/j.surg.2008.08.032 CrossRefPubMed

41.

Pahwa M, Pahwa AR, Batra R, Abraham RR, Chawla A, Kathuria S, Sharma A (2015) Robotic assisted laparoscopic adrenalectomy: initial experience from a tertiary care centre in India. J Minim Access Surg 11:83–86. https://doi.org/10.4103/0972-9941.147704 CrossRefPubMedPubMedCentral

42.

Brunaud L, Bresler L, Ayav A, Tretou S, Cormier L, Klein M, Boissel P (2003) Advantages of using robotic Da Vinci system for unilateral adrenalectomy: early results. Ann Chir 128:530–535CrossRefPubMed

43.

Brunaud L, Bresler L, Zarnegar R, Ayav A, Cormier L, Tretou S, Boissel P (2004) Does robotic adrenalectomy improve patient quality of life when compared to laparoscopic adrenalectomy? World J Surg 28:1180–1185. https://doi.org/10.1007/s00268-004-7559-1 CrossRefPubMed

44.

Lairmore TC, Folek J, Govednik CM, Snyder SK (2016) Improving minimally invasive adrenalectomy: selection of optimal approach and comparison of outcomes. World J Surg 40:1625–1631. https://doi.org/10.1007/s00268-016-3471-8 CrossRefPubMed

45.

Morelli L, Tartaglia D, Bronzoni J, Palmeri M, Guadagni S, di Franco G, Gennai A, Bianchini M, Bastiani L, Moglia A, Ferrari V, Fommei E, Pietrabissa A, di Candio G, Mosca F (2016) Robotic assisted versus pure laparoscopic surgery of the adrenal glands: a case-control study comparing surgical techniques. Langenbeck's Arch Surg 401:999–1006. https://doi.org/10.1007/s00423-016-1494-0 CrossRef

46.

Brunaud L, Bresler L, Ayav A, Zarnegar R, Raphoz AL, Levan T, Weryha G, Boissel P (2008) Robotic-assisted adrenalectomy: what advantages compared to lateral transperitoneal laparoscopic adrenalectomy? Am J Surg 195:433–438. https://doi.org/10.1016/j.amjsurg.2007.04.016 CrossRefPubMed

47.

Karabulut K, Agcaoglu O, Aliyev S, Siperstein A, Berber E (2012) Comparison of intraoperative time use and perioperative outcomes for robotic versus laparoscopic adrenalectomy. Surgery 151:537–542. https://doi.org/10.1016/j.surg.2011.09.047 CrossRefPubMed

48.

Aksoy E, Taskin HE, Aliyev S, Mitchell J, Siperstein A, Berber E (2013) Robotic versus laparoscopic adrenalectomy in obese patients. Surg Endosc 27:1233–1236. https://doi.org/10.1007/s00464-012-2580-1 CrossRefPubMed

49.

Wu JC-H, Wu H-S, Lin M-S et al (2008) Comparison of robot-assisted laparoscopic adrenalectomy with traditional laparoscopic adrenalectomy - 1 year follow-up. Surg Endosc 22:463–466. https://doi.org/10.1007/s00464-007-9488-1 CrossRefPubMed

50.

Agcaoglu O, Aliyev S, Karabulut K, Siperstein A, Berber E (2012) Robotic vs laparoscopic posterior retroperitoneal adrenalectomy. Arch Surg 147:272–275. https://doi.org/10.1001/archsurg.2011.2040 CrossRefPubMed

51.

Berber E, Mitchell J, Milas M, Siperstein A (2010) Robotic posterior retroperitoneal adrenalectomy: operative technique. Arch Surg 145:781–784. https://doi.org/10.1001/archsurg.2010.148 CrossRefPubMed

52.

Ludwig AT, Wagner KR, Lowry PS, Papaconstantinou HT, Lairmore TC (2010) Robot-assisted posterior retroperitoneoscopic adrenalectomy. J Endourol 24:1307–1314. https://doi.org/10.1089/end.2010.0152 CrossRefPubMed

53.

Agcaoglu O, Akbas M, Ozdemir M, Makay O (2019) The impact of body mass index on perioperative outcomes of robotic adrenalectomy: an update. Surg Innov 155335061985885. https://doi.org/10.1177/1553350619858854 CrossRefPubMed

54.

Takagi T, Kondo T, Tachibana H, Iizuka J, Omae K, Kobayashi H, Yoshida K, Tanabe K (2017) Robot-assisted laparoscopic versus open partial nephrectomy in patients with chronic kidney disease: a propensity score-matched comparative analysis of surgical outcomes. Int J Urol 24:505–510. https://doi.org/10.1111/iju.13363 CrossRefPubMed

55.

Tiberio GAM, Solaini L, Arru L, Merigo G, Baiocchi GL, Giulini SM (2013) Factors influencing outcomes in laparoscopic adrenal surgery. Langenbeck's Arch Surg 398:735–743. https://doi.org/10.1007/s00423-013-1082-5 CrossRef

56.

Fiori C, Checcucci E, Amparore D et al (2019) Adrenal tumours: open surgery versus minimally invasive surgery. Curr Opin Oncol. https://doi.org/10.1097/CCO.0000000000000594 CrossRefPubMed

57.

Ruhle BC, Ferguson Bryan A, Grogan RH (2019) Robot-assisted endocrine surgery: indications and drawbacks. J Laparoendosc Adv Surg Tech A 29:129–135. https://doi.org/10.1089/lap.2018.0308 CrossRefPubMed

58.

Yiannakopoulou E (2016) Robotic assisted adrenalectomy: surgical techniques, feasibility, indications, oncological outcome and safety. Int J Surg 28:169–172. https://doi.org/10.1016/j.ijsu.2016.02.089 CrossRefPubMed

59.

Alemanno G, Bergamini C, Prosperi P, Valeri A (2017) Adrenalectomy: indications and options for treatment. Updat Surg 69:119–125. https://doi.org/10.1007/s13304-017-0441-0 CrossRef

60.

Nomine-Criqui C, Germain A, Ayav A, Bresler L, Brunaud L (2017) Robot-assisted adrenalectomy: indications and drawbacks. Updat Surg 69:127–133. https://doi.org/10.1007/s13304-017-0448-6 CrossRef

Title: Comparing the efficacy and safety of laparoscopic and robotic adrenalectomy: a meta-analysis and trial sequential analysis
Authors: Konstantinos Perivoliotis
Ioannis Baloyiannis
Chamaidi Sarakatsianou
George Tzovaras
Publication date: 01-03-2020
Publisher: Springer Berlin Heidelberg
Keywords: Adrenalectomy
Adrenalectomy
Published in: Langenbeck's Archives of Surgery / Issue 2/2020
Print ISSN: 1435-2443
Electronic ISSN: 1435-2451
DOI: https://doi.org/10.1007/s00423-020-01860-9

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Comparing the efficacy and safety of laparoscopic and robotic adrenalectomy: a meta-analysis and trial sequential analysis

Abstract

Purpose

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 2/2020

Prospective study on predictability of complications by pancreatic surgeons

A retrospective case control study identifies peripheral blood mononuclear cell albumin RNA expression as a biomarker for non-alcoholic fatty liver disease

Comparison of open and endovascular repair of juxtarenal abdominal aortic aneurysms

Ligating the rectum with cable tie facilitates rectum transection in laparoscopic anterior resection of rectal cancer

Long-term outcome of surgical resection in patients with gastroenteropancreatic neuroendocrine neoplasia: results from a German nation-wide multi-centric registry

Feasibility and usability of real-time intraoperative quantitative fluorescent-guided perfusion assessment during resection of gastroesophageal junction cancer