# Surgery for adrenal gland disease. Experience of a tertiary center

## TL;DR

This paper examines the shift from open to minimally invasive adrenal surgery at a tertiary center, showing benefits like shorter recovery times and less blood loss.

## Contribution

The study provides real-world data on the adoption and outcomes of laparoscopic and robotic adrenalectomy in a tertiary center over a 16-year period.

## Key findings

- Minimally invasive adrenalectomy was associated with shorter hospital stays and less blood loss compared to open surgery.
- Robotic adrenalectomy had the lowest intraoperative blood loss but was less commonly used than laparoscopic surgery.
- Conversion to open surgery was rare, and postoperative complications were low overall.

## Abstract

Laparoscopic adrenalectomy and robotic adrenalectomy are increasingly accepted methods for removing adrenal lesions, especially for benign conditions. This study investigated the evolution of surgical techniques and patient characteristics at a tertiary centre during the transition from open to minimally invasive surgery.

The analysis included all adrenal surgery cases referred to our institution between January 2009 and June 2025. The following were recorded for each patient: demographics, diagnosis, surgical approach, intraoperative blood loss, histology, length of hospital stays, and complications.

A total of 292 adrenalectomies were performed (56% female; mean age 54.5 ± 12.6 years). The left adrenal was more frequently affected (59%), and the mean tumor size was 46.8 ± 25.1 mm. Indications included primary hyperaldosteronism (37%), Cushing's syndrome (28%), pheochromocytoma (15%), adrenal cysts or myelolipomas (17%), adrenocortical carcinomas (4%), and adrenal metastases (2%). Laparoscopy was the most common approach (76%), followed by open (10%) and robotic adrenalectomy (9%); overall 7 (2%) patients required conversion to open surgery and postoperative morbidity was 7%. Minimally invasive procedures were associated with shorter operative times, less blood loss, and shorter in-hospital stays when compared to open surgery (p < 0.05). Robotic adrenalectomy had the lowest intraoperative blood loss, while laparoscopy had the fastest operative time.

Minimally invasive adrenalectomy is safe and effective for adrenal tumors. In our series, robotic-assisted surgery is becoming increasingly prevalent and has excellent results; however, its implementation needs to be balanced with the associated costs.

Unlabelled Image