Adrenalectomy Performed with the Da Vinci Single-Port Robotic System: A Systematic Review and Pooled Analysis

Area of Science:

• Minimally Invasive Surgery
• Surgical Oncology
• Robotic Surgery

Background:

• The Da Vinci Single-Port (DV-SP) system, introduced in 2018, has limited documented evidence regarding its application and perioperative results in robot-assisted adrenalectomy (RAA).
• Assessing the efficacy and safety of novel surgical platforms is crucial for advancing minimally invasive techniques.

Purpose of the Study:

• To systematically evaluate the feasibility, reproducibility, and safety of robot-assisted adrenalectomy using the Da Vinci Single-Port (DV-SP) system.
• To analyze perioperative outcomes including operative time, estimated blood loss, and complication rates.

Main Methods:

• A systematic literature search was conducted across PubMed, Scopus, Ovid, and Web of Science in December 2024.
• Five retrospective studies involving 342 adult patients with adrenal masses undergoing DV-SP RAA were included.
• Quantitative analysis employed random-effect or fixed-effect models, with a risk of bias assessment performed.

Main Results:

• The pooled mean operative time was 92.5 minutes, with a mean estimated blood loss (EBL) of 26.5 mL.
• Most procedures utilized a single incision (91%), and perioperative complications were rare (0%).
• DV-SP RAA demonstrated improved operative techniques and cosmetic outcomes compared to other robotic systems, with no significant difference in complications versus multi-port (MP) RAA.

Conclusions:

• Robot-assisted adrenalectomy with the DV-SP system is a promising approach, offering reduced operative time, low EBL, and excellent cosmetic results.
• The DV-SP RAA appears reproducible, feasible, and safe, though limitations include small sample sizes and potential selection bias in current studies.
• Further randomized controlled trials comparing DV-SP RAA with multi-port RAA are warranted to confirm these findings and enhance generalizability.