title: Robot-assisted versus laparoscopic adrenalectomy: a systematic review and meta-analysis.
abstract: BACKGROUND
  More recently, robot-assisted adrenalectomy (RA) has emerged as an attractive alternative to laparoscopic adrenalectomy (LA), and many studies have shown the feasibility and safety of RA. However, the short- and long-term outcomes of RA versus LA have not been adequately assessed, and the advantage over the laparoscopic approach has not been demonstrated. The aim of this study was to compare the outcomes of RA versus LA by means of a systematic review and meta-analysis of the available literature in the early experience.
  
  
  METHODS
  A systematic search of PubMed, SCI/SSCI, CNKI, and the Cochrane Library was performed to identify prospective randomized controlled trials and retrospective observational studies that compared RA and LA and were published between January 2006 to the end of December 2012. Outcomes of interest included demographic and clinical characteristics, perioperative variables, and complications. The meta-analysis was prepared in accordance with the Quality of Reporting of Meta-analyses (QUOROM) statement.
  
  
  RESULTS
  Eight trials (232 cases and 297 controls) assessing RA versus LA were considered suitable for meta-analysis, including six prospective and two retrospective studies. There was a significant trend to choose patients for the performance of RA who were associated with a lower body mass index (weighted mean difference [WMD]=-2.78 kg/m(2); 95% confidence interval [CI], -3.00 to -2.55; P<.001) and higher incidence of previous surgery (odds ratio=1.59; 95% CI, 0.99-2.54; P=.05). There were no significant differences between the two groups in any other of the demographic parameters. With regard to perioperative variables, although there was a significant difference in the operating time in favor of LA (WMD=17.52 minutes; 95% CI, 3.48-31.56; P=.01), patients having RA might benefit from significantly less blood loss (WMD=-19.00 mL; 95% CI, -34.58 to -3.41; P=.02) and shorter length of hospital stay (WMD=-0.35 day; 95% CI, -0.51 to -0.19; P<.001). There were no significant differences between RA and LA with regard to conversion rates and overall complications. Sensitivity analysis performed by two methods both showed a positive reversal in the operating time with the statistical significance removed compared with the original analysis.
  
  
  CONCLUSIONS
  In the early experience, our data suggest that RA, compared with LA, may be a safe and feasible option associated with less blood loss and shorter hospital stay when performed by experienced surgeons in selected patients.
authors.affiliation: Department of Urology and Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology , Wuhan, China .
authors.forename: Kun
authors.initials: K
authors.lastname: Tang
authors.forename: Heng
authors.initials: H
authors.lastname: Li
authors.forename: Ding
authors.initials: D
authors.lastname: Xia
authors.forename: Gan
authors.initials: G
authors.lastname: Yu
authors.forename: Xiaolin
authors.initials: X
authors.lastname: Guo
authors.forename: Wei
authors.initials: W
authors.lastname: Guan
authors.forename: Hua
authors.initials: H
authors.lastname: Xu
authors.forename: Zhangqun
authors.initials: Z
authors.lastname: Ye
mesh_terms: D000315:Adrenalectomy / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D015233:Models, Statistical; D017063:Outcome Assessment, Health Care; D065287:Robotic Surgical Procedures