Efficacy and safety of laparoendoscopic single-site adrenalectomy versus conventional laparoscopic adrenalectomy: an updated systematic review and meta-analysis

Introduction
Laparoendoscopic single-site adrenalectomy (LESSA) has the advantages of early recovery and better cosmetic appearance. However, there are still debates on the efficacy and safety of LESSA and conventional laparoscopic adrenalectomy (CLA).

Aim: To reevaluate the efficacy and safety of LESSA vs CLA for adrenal lesions.

Material and methods
A systematic literature research of PubMed, Ovid, Scopus (up to February 2021), and citation lists was performed to identify eligible studies. All studies comparing LESSA versus CLA were included. Data were analyzed using the RevMan 5.4 software.

Results
Overall, eighteen studies including 1307 patients (LESSA 520; CLA 787) were included. LESSA was associated with smaller mean tumor size (weighted mean difference (WMD) = 0.53 cm, 95% CI: –0.81 to –0.24; p < 0.001). The operative time for LESSA was longer than CLA (WMD = 13.86 min, 95% CI: 4.43 to 23.30; p = 0.004). LESSA had a better visual analog scale (VAS) score (WMD = –0.56, 95% CI: –1.01 to –0.11; p = 0.02), shorter return to diet time (WMD = –0.27 days, 95% CI: –0.52 to –0.03; p = 0.03), shorter length of hospital stay (WMD = –0.56 days, 95% CI: –1.01 to –0.11; p = 0.01), and comparable postoperative complications (OR = 0.98, 95% CI: 0.56 to 1.70; p = 0.93). The wound size of LESSA was definitely smaller (WMD = –2.72 cm, 95% CI: –3.50 to –1.94; p < 0.001). The subgroup analysis of studies via the transperitoneal approach showed reasonable results.

Conclusions
LESSA is significantly better in terms of postoperative pain, time to diet, length of hospital stay and wound size, but the operative time is significantly longer.