Portal de Periódicos da CAPES

Innovation in endocrine surgery: robotic versus laparoscopic adrenalectomy. Meta-analysis and systematic literature review

2017; Impact Journals LLC; Volume: 8; Issue: 60 Linguagem: Inglês

10.18632/oncotarget.22059

1949-2553

Antonino Agrusa, Giorgio Romano, Giuseppe Navarra, Giovanni Conzo, Gianni Pantuso, Giuseppe Di Buono, Roberto Citarrella, Massimo Galia, A. Lo Monte, Gaspare Cucinella, Gaspare Gulotta,

Cancer, Hypoxia, and Metabolism

// Antonino Agrusa 1 , Giorgio Romano 1 , Giuseppe Navarra 2 , Giovanni Conzo 3 , Gianni Pantuso 4 , Giuseppe Di Buono 1 , Roberto Citarrella 5 , Massimo Galia 6 , Attilio Lo Monte 1 , Gaspare Cucinella 7 and Gaspare Gulotta 1 1 Department of General Surgery, Urgency and Organ Transplantation, University of Palermo, Palermo, Italy 2 Department of Human Pathology University Hospital of Messina, Messina, Italy 3 Department of Anesthesiologic, Surgical and Emergency Sciences, Division of General and Oncologic Surgery, School of Medicine, Second University of Naples, Naples, Italy 4 Department of Surgery and Oncology, University of Palermo, Palermo, Italy 5 Department of Experimental Biomedicine and Clinical Neurosciences, University of Palermo, Palermo, Italy 6 Section of Radiology - Di.Bi.Me.F., University of Palermo, Palermo, Italy 7 Department of Obstetrics and Gynecology, University of Palermo, Palermo, Italy Correspondence to: Antonino Agrusa, email: antonino.agrusa@unipa.it Keywords: laparoscopic adrenalectomy, robotic adrenalectomy, laparoscopic surgery, robotic surgery, adrenal surgery Received: July 18, 2017 Accepted: September 23, 2017 Published: October 19, 2017 ABSTRACT 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.