Surgical outcomes of a randomized controlled trial compared robotic versus laparoscopic adrenalectomy for pheochromocytoma

Ma, Wenqi; Mao, Yongxin; Zhuo, Ran; Dai, Jun; Chen, Fang; Wang, Chenghe; Zhao, Juping; He, Wei; Zhu, Yu; Xu, Danfeng; Sun, Fenyong

doi:10.1016/j.ejso.2020.04.001

Cited by 28 publications

(43 citation statements)

References 33 publications

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“…We performed a metaanalysis of these studies including 1376 patients. Ma et al and Morino et al published the only 2 randomized clinical trials (RCT) comparing RA to LA [23,24]. We did not found significant differences in the demographics and preoperative characteristics except for BMI which was lower in the robotic group.…”

Section: Discussioncontrasting

confidence: 60%

“…From our systematic literature review we identified 18 studies which were eligible in our study. 10 of them were prospective [12,18,19,20,13,21,22,23,24,25] and 8 were retrospective [26,27,28,29,30,31,32,33]. Seven of these studies were conducted in USA, 5 in Korea, two in Italy, one in Taiwan, one in France, one in China and one was share between Italy and France.…”

Section: Resultsmentioning

confidence: 99%

“…However, one previous meta-analysis didn't report this difference in the operative time between both groups [37].In addition three of our studies reported shorter operative time for the robotic than the laparoscopic technique [19,27,28] . In one study [23], when the docking time was excluded, the operative time was significantly lower in the robotic group (112.5 ±13.75m) than the laparoscopic group ±20m). In addition, Agcaoglu et al described the presence of a learning curve and reported a significant improvement in the operative time after the first 10 robotic procedures ; Article no.CJAST.69431 CI = confidence interval; RD CI = confidence interval; RD = analysis didn't report this difference in the operative time .In addition three of our s reported shorter operative time for the robotic than the laparoscopic technique , when the docking time was excluded, the operative time was significantly lower in the robotic group (112.5 ±13.75m) than the laparoscopic group (123.75 ±20m).…”

Section: Discussionmentioning

confidence: 98%

“…We found no significant differences in terms of intraoperative and postoperative complications, mortality, and conversion to laparotomy or laparoscopy/laparotomy. Laparoscopic approach seems to be a more rapid technique when comparing to RA, although recent studies [23,27,28] demonstrate a significant operative time reduction in RA with the learning curve improvement and the development of new surgical technology.…”

Section: Discussionmentioning

confidence: 99%

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Robotic Versus Laparoscopic Adrenalectomy: Systemic Review

Rezkallah

Elsaify

et al. 2021

CJAST

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Background: Minimal invasive surgery has become the standard for most surgical procedures now. Many studies have tried to compare robotic versus laparoscopic to adrenalectomy. Objectives: The aim of this study is to review most of the available studies comparing robotic to laparoscopic adrenalectomy to evaluate which procedure provides the superior clinical outcomes. Methods: A systematic literature search of ScienceDirect and PubMed databases. The perioperative clinical outcomes were collected by two independent reviewers. We used Random-effects (DerSimonian-Laird) models to get the pooled effect estimates. Results: 18 studies were eligible in our study. 10 of them were prospective and 8 were retrospective. A total of 1376 patients underwent adrenalectomy, 592 (43.02%) were treated with RA and 784 (56.9%) with the LA technique. There were no significant differences between both groups regarding the conversion rate (Odds ratio: 0.70, 95% CI 0.31-1.57, P= 0.65), intraoperative complications (OR: 2.18, 95% CI 0.49- 9.71, P= 0.28), post-operative complications (OR: 0.83, 95% CI: 0.55-1.24, P= 0.49), and mortality (OR: 0.42, 95% CI: 0.07-2.72, P= 0.98). However, robotic adrenalectomy was associated with longer operative times (MD: 9.89 min, 95% CI: -2.79 to 22.58), shorter hospital stay (MD: -0.33, 95% CI: -0.46 to -0.21) with less blood loss (MD: -25.34, 95% CI: -36.77 to -13.91). Conclusions: We proved that robotic adrenalectomy has equal safety and feasibility with similar clinical outcomes when compared with laparoscopic approach. However, better well-designed studies are required to determine the role and cost-effectiveness of robotic adrenal surgery.

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Section: Discussioncontrasting

confidence: 60%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

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Robotic Versus Laparoscopic Adrenalectomy: Systemic Review

Rezkallah

Elsaify

et al. 2021

CJAST

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“…Data on LOS were recorded in 4 studies involving 386 patients (Figure 3C) (8)(9)(10)14). The merged results identified that RA had a shorter postoperative LOS than LA (OR: -0.50; 95% CI: -0.55 to 0.45; I 2 = 31%; P<0.01).…”

Section: Length Of Hospital Staymentioning

confidence: 99%

Comparison of Perioperative Outcomes of Robotic-Assisted vs Laparoscopic Adrenalectomy for Pheochromocytoma: A Meta-Analysis

Xia

Peng

et al. 2021

Front. Oncol.

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ObjectiveTo compare the efficacy and safety of robotic-assisted adrenalectomy (RA) and standard laparoscopic adrenalectomy (LA) for pheochromocytoma (PHEO).MethodsWe systematically searched the Cochrane Library, PubMed, Embase, and Science databases for studies published through January 2021. Controlled trials on RA and LA for PHEOs were included. The meta-analysis was conducted with the Review Manager 5.4 software.ResultsFour studies with 386 patients were included in the analysis. There were no significant differences in OT (WMD: 0.16; 95% CI: -28.50 to 28.82; I2 = 89%; P = 0.99), transfusion rate (OR: 0.70; 95% CI: 0.07 to 7.07; I2 = 64%; P = 0.77), conversion rate (OR: 0.44; 95% CI: 0.07 to 2.88; I2 = 0%; P = 0.39), complication rate (OR: 1.06; 95% CI: 0.62 to 1.82; I2 = 0%; P = 0.84) among patients undergoing RA and LA. However, compared with patients who underwent LA, patients who underwent RA had a shorter LOS (OR: -0.50; 95% CI: -0.55 to 0.45; I2 = 31%; P<0.01), less EBL (WMD: -0.85; 95% CI: -13.56 to -2.54; I2 = 44%; P<0.01), and fewer IHD (OR: 0.34; 95% CI: 0.17 to 0.70; I2 = 0%; P<0.01).ConclusionThe RA for pheochromocytoma achieve better outcomes over LA in terms of safety and efficacy.

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Laparoscopic versus robotic adrenalectomy in pheochromocytoma patients

Isiktas

Avci

Ergun

et al. 2022

Journal of Surgical Oncology

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Background and Objectives Pheochromocytoma is a challenging tumor type requiring resection with a clear margin and an intact capsule to prevent recurrences. Our aim was to compare perioperative outcomes of laparoscopic adrenalectomy (LA) versus robotic adrenalectomy (RA) for pheochromocytoma. Methods In an institutional review board‐approved retrospective study, clinical parameters of patients who underwent LA versus RA at a single center were compared using Mann–Whitney U, χ2, and survival analyses. Continuous data are expressed as median (interquartile range). Results There was a total of 157 patients (RA: n = 87, LA: n = 70) analyzed. Estimated blood loss (36.3 [35.0] vs. 99.9 [65.0] cc, p = 0.020) and hospital stay (1.3 [0.0] vs. 2.2 [1.0] days, p = 0.010) were lower in robotic versus laparoscopic group, respectively. Disease‐free and overall survival was similar between groups. The rate of conversion to open for tumors ≥5 cm was less in the robotic group (0% vs. 14%, respectively, p = 0.048). Conclusion In this study, long‐term outcomes of LA and RA were similar, although adrenalectomies performed robotically were associated with less blood loss, shorter hospital stay, and a lower chance of conversion to open in the case of large tumors.

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Surgical outcomes of a randomized controlled trial compared robotic versus laparoscopic adrenalectomy for pheochromocytoma

Cited by 28 publications

References 33 publications

Robotic Versus Laparoscopic Adrenalectomy: Systemic Review

Robotic Versus Laparoscopic Adrenalectomy: Systemic Review

Comparison of Perioperative Outcomes of Robotic-Assisted vs Laparoscopic Adrenalectomy for Pheochromocytoma: A Meta-Analysis

Laparoscopic versus robotic adrenalectomy in pheochromocytoma patients

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