Surgical Efficacy of Robotic Adrenalectomy: Korean Nationwide Comparative Data Analysis Focusing on Robotic Modality,Surgical Approach,and Tumor Characteristics

Abstract

Purpose:

Despite insufficient evidence of safety, single-port robotic surgery is becoming increasingly popular. This retrospective study compared the surgical efficacy of single-port robotic adrenalectomy (RA) and conventional multi-port RA.

Materials and Methods:

Data were collected from 303 patients who underwent RA across seven centers from January 2018 to June 2024.

Results:

The mean age of the patients was 51.6 ± 12.8 years, and 41.3% (125/303) of them were male. Left-sided adrenal tumors were present in 58.1% (176/303) of the patients. Clinical tumor size was 3.5 ± 2.0 cm. Robotic partial adrenalectomy, retroperitoneal, and single-port RAs were performed in 96 (31.7%), 57 (18.8%), and 42 (13.9%) patients, respectively. A Jackson–Pratt drain was not inserted in 69 cases (22.8%), and hospital stay was 4.3 ± 1.7 days. Given the different patient selection criteria for multi-port and single-port RAs, propensity score matching (PSM) was conducted according to the laterality of the procedure, tumor size, and tumor characteristics. After PSM, intraoperative and postoperative (≥30 days) complication rates were not different between the multi-port and single-port RA groups. The incidence of complications was not significantly different between the two groups when the tumor size was stratified as 4 cm (2.0% versus 3.7%). Multivariate logistic regression analysis revealed that the surgical method (multi-port versus single-port) was not associated with perioperative complications. Instead, it depended on whether the tumor was a cortical carcinoma or a pheochromocytoma.

Conclusion:

Both multi- and single-port RAs are safe. In certain patients, single-port RA can be an alternative surgical option.