Robotic-assisted versus laparoscopic adrenalectomy for large adrenal tumors: a systematic review and meta-analysis.

Background: The application of robotic adrenalectomy (RA) is increasing. However, there is still controversy over whether RA is more feasible than laparoscopic adrenalectomy (LA) for large adrenal tumors (LATs).

Methods: This meta-analysis compares the efficacy and safety of RA versus LA for LATs. A systematic literature search of PubMed, the Cochrane Library, Embase, CNKI, WANFANG database, and other databases (up to December 2024) was performed to identify studies comparing RA and LA. Data were analyzed using the Cochrane Collaboration's Review Manager (RevMan) 5.3 software.

Results: Overall, eight studies with 601 patients were included in the analysis. There were no statistically significant differences between the two groups in operative time (SMD = -0.65, 95% CI -1.48 to 0.18; P = 0.12), transfusion rate (OR = 1.12, 95% CI 0.59 to 2.16; P = 0.73), hemodynamic instability (OR = 0.67, 95% CI 0.23 to 1.92; P = 0.46), postoperative transfer to SICU (OR = 1.26, 95% CI 0.15 to 10.51; P = 0.83). Patients from the RA group could benefit from less occurrence of conversion to open (OR = 0.18, 95% CI 0.05 to 0.59; P = 0.005), lower EBL (SMD = -1.11, 95% CI -1.71 to -0.52; P = 0.0002), quicker time to removal of drainage (SMD = -1.12, 95% CI -2.03 to -0.21; P = 0.02), and shorter length of hospital stay (SMD = -1.61, 95% CI -2.41 to -0.81; P < 0.0001, I = 94%). Meanwhile, it should be noted that the RA group produces higher cost compared to the LA group (SMD = 24.12, 95% CI 12.96 to 35.29; P < 0.0001, I = 99%).

Conclusions: Compared to LA, RA has higher advantages in certain aspects. RA is an effective and safe treatment option for LATs.