# Robotic Adrenalectomy: A Portuguese National Health Service Experience

## TL;DR

This paper reports on the successful implementation of robotic adrenalectomy in a public hospital, showing it is safe and effective for both benign and complex adrenal cases.

## Contribution

The study provides real-world evidence of robotic adrenalectomy outcomes in a public healthcare setting, highlighting its feasibility and potential for complex cases.

## Key findings

- Thirty-two robotic adrenalectomies were performed with a mean operative time of 110 minutes and low complication rates.
- Robotic adrenalectomy showed benefits in complex cases, with no mortality and a short mean hospital stay of 1.2 days.
- Conversion to open surgery occurred in only 3% of cases, indicating the procedure's overall safety and effectiveness.

## Abstract

Introduction: Minimally invasive adrenalectomy is currently the gold-standard approach for the surgical management of benign adrenal disease. In recent years, robotic-assisted adrenalectomy has gained increasing acceptance, offering technical advantages that may be particularly relevant in complex cases. The implementation of an endocrine robotic surgery program in a public hospital presents specific organizational and technical challenges.

Methods: We report a consecutive series of robotic transabdominal adrenalectomies performed at a tertiary, university-affiliated public hospital between April 2024 and December 2025. Demographic, perioperative, and postoperative outcomes were retrospectively analyzed.

Results: Thirty-two robotic adrenalectomies were performed (17 right-sided, 15 left-sided). The mean adrenal gland diameter was 6.2 cm, with a mean tumor diameter of 3.0 cm. Mean operative time was 110 minutes. Conversion to open surgery occurred in one patient (3%). Overall morbidity was 9.4%, including one pancreatic fistula and one incisional hernia requiring reoperation. There was no mortality. The mean hospital stay was 1.2 days.

Discussion: Our perioperative outcomes are comparable to those reported in the literature. Robotic adrenalectomy provides excellent visualization, enhanced dexterity, and ergonomic benefits, which may facilitate dissection in anatomically demanding situations. Emerging evidence suggests a potential role for robotic platforms in large, malignant, or technically complex adrenal tumors traditionally excluded from minimally invasive surgery.

Conclusion: Robotic adrenalectomy is a safe and feasible technique when implemented in specialized centers by experienced surgical teams. Its role may extend beyond benign disease to selected complex adrenal cases, although further studies are required to define its indications and cost-effectiveness.