Laparoscopic vs Robotic Adrenalectomy: A Systematic Review and Meta-Analysis

Objective: Comparing the safety and effectiveness of robot-assisted laparoscopic adrenalectomy (RA) vs laparoscopic adrenalectomy (LA) in various adrenal tumors. Methods: We conducted this systematic review and meta-analysis of the primary outcomes of interest according to the PRISMA and AMSTAR guidelines. Five databases were systematically searched, including Medline, PubMed, Cochrane Library, Scopus, and Web of Science. The search time frame was set from database creation to January 2025. Results: There were 45 studies, including 7225 patients. Compared with LA, RA was superior in terms of estimated blood loss (EBL) [weighted mean difference (WMD) = -20.89, 95% confidence interval or CI (-28.51, -13.28), P < 0.01], length of stay (LOS) [WMD = -0.28, 95% CI (-0.40, -0.17), P < 0.01], bowel recovery time [WMD = -0.54, 95% CI (-0.82, -0.27), P < 0.01], conversion [odds ratio (OR) = 0.39, 95% CI (0.25, 0.60), P < 0.01], and total complications [OR = 0.70, 95% CI (0.57, 0.86), P < 0.01]. The two surgical groups were comparable in terms of operative time (OT), transfusion, readmission, Clavien-Dindo I-II complications, and Clavien-Dindo >II complications. Subgroup analyses found that compared with transperitoneal LA (TLA), robot-assisted TLA was superior in terms of EBL [WMD = -22.51, 95% CI (-39.04, -5.98), P < 0.01] and total complications [OR = 0.60, 95% CI (0.39, 0.90), P < 0.05]. The two surgical groups were comparable in terms of OT and LOS. Compared with retroperitoneal LA (RLA), robot-assisted RLA was superior in terms of OT [WMD = 18.74, 95% CI (5.89, 31.58), P < 0.01] and EBL [WMD = -21.41, 95% CI (-36.85, -5.97), P < 0.01]. The two surgical groups were comparable in terms of LOS, and total complications. For pheochromocytomas (PHEOs), RA was superior in terms of EBL, LOS, and intraoperative hemodynamic instability. For large adrenal tumors (≥5 cm), RA was superior in terms of OT, EBL, and LOS. For obesity, RA was superior in terms of EBL. The two surgical groups were comparable in terms of OT, LOS, conversion, and total complications. Conclusion: Robot-assisted laparoscopic procedure is superior to conventional laparoscopic procedure in the treatment of adrenal tumors, particularly for patients with large adrenal tumors (≥5 cm), obesity, and PHEOs.