Comparison Of Surgical Outcomes Between Robot-assisted Laparoscopy And Conventional Laparoscopy In The Treatment Of Giant Adrenal Tumors(≥5cm)

Objective:The advantages of robot-assisted laparoscopic adrenalectomy(RALA)over laparoscopic adrenalectomy(LA)for the treatment of large(≥5 cm)adrenal tumors remain controversial.Intraoperative and postoperative perioperative indicators were collected and analyzed,along with risk factors for various adverse events,to clarify whether robotic-assisted laparoscopic adrenalectomy offers significant advantages.Methods:The clinical data of patients who underwent minimally invasive adrenal tumor(≥5 cm)resection at the First Affiliated Hospital of Nanchang University from January 2010 to December 2021 were retrospectively collected and analyzed.According to the relevant criteria,251 patients were included in this study and divided into RALA group(77 patients)and LA group(174 patients).Both groups completed adrenal-related imaging and relevant laboratory tests such as hematuria,and age,gender,body mass index(BMI),tumor diameter,tumor laterality,underlying disease,history of abdominal surgery,American Society of Anesthesiologists(ASA)classification,surgical approach,hormone secretion level,and pathological type were collected.After propensity matched score analysis(PSM),77 patients in each of the two groups were analyzed to compare the intraoperative and postoperative outcomes of the two groups and divided into two subgroups for comparative analysis based on hormone secretion level and type of pathology.Independent risk factors for adverse events were analyzed by backward elimination method logistic regression by potential risk factors.Results:All 251 patients included completed the procedure successfully,with a 30-day mortality rate of 0.Before PSM,there was a statistically significant difference in hormone secretion levels between patients in the RALA and LA groups(p=0.007),and after PSM,there was no significant difference in general clinical information between the two groups(p>0.05).The results showed that RALA had better surgical outcomes than LA in terms of intraoperative blood loss,intraoperative transfer to open,transfer to ICU,time to first feeding,time to floor,and time to extubation(p<0.05).However,the hospitalization cost was significantly higher in the RALA group than in the LA group.Analyzing the malignancy propensity subgroup and the high hormone secretion level subgroup,we derived similar results for the outcomes.Conclusion:Both RALA and LA are safe and effective for the treatment of giant adrenal tumors,and the robotic surgical platform reduces the risk of intraoperative conversion to open surgery and transfer to the ICU,shortens postoperative recovery time,and reduces the probability of extraordinarily long hospital stays.