Robotic-assisted laparoscopic adrenalectomy was completed without conversion and had low postoperative morbidity with 93.8% of patients experiencing no complications and 6.2% experiencing a Grade II event according to Clavien-Dindo in adults with adrenal tumors.
Observational (n=16)
No
Robotic-assisted laparoscopic adrenalectomy is feasible and safe in a tertiary referral setting, demonstrating low blood loss and minimal perioperative complications.
Effect estimate: Conversion rate 0%
Introduction: Robotic-assisted laparoscopic adrenalectomy (RALA) extends minimally invasive adrenal surgery by adding three-dimensional visualization and wristed instrumentation. While laparoscopic adrenalectomy remains the standard approach, real-world perioperative performance of RALA in tertiary referral settings warrants evaluation. We aimed to describe the feasibility, perioperative outcomes, complications, and histopathology of consecutive patients undergoing RALA at our institution. Materials and methods: We conducted a retrospective observational analysis of consecutive patients undergoing RALA at a tertiary referral center (November 2021-November 2024). Demographic, imaging, operative, and pathologic variables were collected. Complications were graded using the Clavien-Dindo system, with patients without events explicitly reported as Grade 0. Analyses were descriptive. Results: Sixteen patients underwent RALA (10/16 (62.5%) male); median age was 63 years (range 40-83). Median radiologic tumor size was 5.03 cm (range 1.2-12.5). All cases were completed without conversion. Median operative time was 147 minutes (range 70-270), and median estimated blood loss was 105 mL (range 20-250). Postoperative morbidity was low: Grade 0 in 15/16 (93.8%) and one Grade II event in 1/16 (6.2%); no Grade I or Grade III-IV events occurred. Median hospital stay was 7.5 days (range 2-44) overall and three days when excluding a prespecified outlier with bilateral disease and significant comorbidity. Because one patient had bilateral surgery, pathology was reported per lesion (n=17): benign 14/17 (82.4%), malignant 2/17 (11.8%), and indeterminate 1/17 (5.9%); malignancy was suspected preoperatively in one lesion and was an incidental final-pathology finding in the second. Intraoperative ultrasonography was used in one complex case to assist localization. Discussion: These findings align with contemporary reports of low morbidity and reliable completion for RALA, with operative metrics and recovery profiles within published ranges. Technical elements such as early adrenal vein control may support hemodynamic stability in hormonally active tumors, and selective intraoperative ultrasonography can aid dissection when anatomy is distorted. Conclusion: In this early institutional series, RALA was feasible and safe, with zero conversions, low blood loss, and very low complication rates, alongside rapid recovery after sensitivity adjustment for a single outlier. Prospective comparative studies are needed to refine patient selection and to evaluate long-term oncologic outcomes and cost-effectiveness.
Redondo et al. (Fri,) conducted a observational in Adults with radiologically confirmed adrenal tumors selected for robotic-assisted laparoscopic adrenalectomy (RALA) in a tertiary care center, ASA class II-III (n=16). Robotic-assisted laparoscopic adrenalectomy (RALA) was evaluated on Completion of surgery without conversion to open surgery and postoperative morbidity within 30 days graded by Clavien-Dindo classification (Conversion rate 0%). Robotic-assisted laparoscopic adrenalectomy was completed without conversion and had low postoperative morbidity with 93.8% of patients experiencing no complications and 6.2% experiencing a Grade II event according to Clavien-Dindo in adults with adrenal tumors.