title: Laparoscopic versus robotic adrenalectomy: A comprehensive meta-analysis.
abstract: BACKGROUND
  The benefit of robotic adrenalectomy (RA) compared to laparoscopic adrenalectomy (LA) is still debatable. The purpose of this paper was to systematically review and synthesize all available evidence comparing RA to LA so as to evaluate which procedure provides superior clinical outcomes.
  
  
  METHODS
  A systematic literature search of PubMed and Scopus databases was performed with respect to the PRISMA statement (end-of-search date: January 31, 2016). Data on perioperative variables were extracted by three independent reviewers. Data were pooled using a random-effects model.
  
  
  RESULTS
  Twenty-seven studies were included in this review (13 comparative and 14 non-comparative). Overall, 1162 patients underwent adrenalectomy (747 treated with RA and 415 with LA). There was no significant difference between the robotic and the laparoscopic groups for intraoperative complications (OR: 1.20; 95%CI, 0.33-4.38), postoperative complications (OR: 0.69; 95% CI, 0.36-1.31), mortality (OR: 0.42; 95%CI, 0.07-2.72), conversion to laparotomy (OR: 0.51; 95%CI, 0.21-1.23), conversion to laparotomy or laparoscopy (OR: 0.73; 95%CI, 0.32-1.69) and blood loss (WMD: -9.78; 95%, -22.10 to 2.53). For patients treated with RA, there was a significantly shorter hospital stay (WMD: -0.40; 95% CI, -0.64 to -0.17) and a significantly longer operating time (WMD: 15.60; 95%CI, 2.12 to 29.08).
  
  
  CONCLUSIONS
  Robotic adrenalectomy is a safe and feasible procedure with similar clinical outcomes as the laparoscopic approach in selected patient populations. High quality RCTs as well as uniform and detailed reporting of outcomes are needed to determine the role and cost-effectiveness of robotic adrenal surgery in the years to come.
authors.affiliation: Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Society of Junior Doctors, Athens, Greece. Electronic address: economopoulos@sni.gr.
authors.forename: Konstantinos P
authors.initials: KP
authors.lastname: Economopoulos
authors.affiliation: Society of Junior Doctors, Athens, Greece; Aristotle University of Thessaloniki, Medical School, Thessaloniki, Greece.
authors.forename: Konstantinos S
authors.initials: KS
authors.lastname: Mylonas
authors.affiliation: Society of Junior Doctors, Athens, Greece; University of Athens, School of Medicine, Athens, Greece.
authors.forename: Aliki A
authors.initials: AA
authors.lastname: Stamou
authors.affiliation: Society of Junior Doctors, Athens, Greece; University of Athens, School of Medicine, Athens, Greece.
authors.forename: Vasileios
authors.initials: V
authors.lastname: Theocharidis
authors.affiliation: Society of Junior Doctors, Athens, Greece; Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, University of Athens, Athens, Greece.
authors.forename: Theodoros N
authors.initials: TN
authors.lastname: Sergentanis
authors.affiliation: Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, University of Athens, Athens, Greece.
authors.forename: Theodora
authors.initials: T
authors.lastname: Psaltopoulou
authors.affiliation: Department of Surgery, Mayo Clinic, Rochester, MN, USA.
authors.forename: Melanie L
authors.initials: ML
authors.lastname: Richards
mesh_terms: D000315:Adrenalectomy / Q000379:methods*; D006801:Humans; D007431:Intraoperative Complications; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay; D061646:Operative Time; D011183:Postoperative Complications; D012371:Robotics / Q000379:methods*
keywords: Laparoscopic adrenalectomy; Meta-analysis; Robot-assisted adrenalectomy; Robotic adrenalectomy