Day-case robotic adrenalectomy under ERAS protocol: early outcomes from a single-centre experience

Abstract Purpose To evaluate the feasibility and outcomes of a day-case robotic adrenalectomy programme implemented within a structured Enhanced Recovery After Surgery (ERAS) framework. Materials and methods A retrospective analysis was conducted of all patients who underwent day-case robotic adrenalectomy between November 2023 and March 2025. Procedures were performed via a transperitoneal approach using the da Vinci Xi ® system and managed under an ERAS protocol incorporating multimodal analgesia, early mobilisation, and omission of postoperative drains and catheters. A transversus abdominis plane (TAP) block was administered intraoperatively for analgesia. Outcomes included operative metrics, perioperative complications, 30-day readmissions, and patient-reported satisfaction measured by the Evaluation du Vécu de l’Anesthésie Générale (EVAN-G) questionnaire. Results Thirteen patients were included. The median age was 49.0 years (46.0–60.0), and the median BMI was 30.0 kg/m² (28.0–36.5). Most patients were male (61.5%, n = 8), all were ASA grade 2, and 69.2% ( n = 9) had an ECOG performance status of 0. The median estimated blood loss was 10.0 mL (5.0–10.0) and the median operative time was 56.0 min (30.5–75.0 min). A history of prior abdominal surgery was present in 38.5% of patients ( n = 5). Indications included primary hyperaldosteronism (69.2%, n = 9), androgen-producing tumour ( n = 1), RCC metastasis ( n = 1), and adrenocortical carcinoma ( n = 2). No intraoperative or postoperative complications occurred, no patients required readmission, and the median EVAN-G score was 94 (91–96). On preoperative imaging, the median tumour size was 16.0 mm (13.0–26.5 mm). Postoperative pathological analysis reported a median adrenal gland size of 63.0 mm (50.0–72.5 mm) and a median lesion size of 15.0 mm (9.0–22.5 mm). Conclusion Day-case robotic adrenalectomy performed under an ERAS protocol is safe and well-tolerated in selected patients.