# Initial Experience With Robotic-Assisted Laparoscopic Adrenalectomy in a Tertiary Center: Feasibility, Perioperative Outcomes, and Histopathology

## TL;DR

This paper reports on the early use of robotic-assisted adrenal surgery at a major hospital, showing it is safe and effective with low complication rates.

## Contribution

The study provides real-world data on robotic-assisted laparoscopic adrenalectomy outcomes in a tertiary center.

## Key findings

- RALA was completed without conversion in all 16 cases with low complication rates.
- Median blood loss was 105 mL and most patients had very short hospital stays.
- Most adrenal lesions were benign, with malignancy detected in only two cases.

## Abstract

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.