Background and purpose <p>As an emerging interactive display technology, mixed reality(MR) allows for the integration of multi-dimensional virtual objects with the real world, enhancing the precision of surgical operations. This technology has demonstrated significant value in renal tumor surgeries, but its application in adrenal tumor surgeries remains unclear. This study aims to investigate the clinical efficacy and potential benefits of mixed reality technology in robot-assisted laparoscopic partial adrenalectomy (RALPA) for treating adrenal tumors.</p> Patients and methods <p>A total of 82 eligible patients who underwent RALPA for adrenal tumors at the Second Affiliated Hospital of Nanchang University from September 2020 to October 2024 were included in this retrospective study. The patients were divided into two groups based on their preoperative diagnosis and treatment: 32 patients in the mixed reality (MR)group and 50 patients in the traditional CT imaging (control) group. All patients received bilateral adrenal gland CT scans, both plain and enhanced. The MR group utilized CT data to create a virtual model, which was then used for surgical planning and intraoperative guidance through a 3D tablet computer and Hololens glasses. Preoperative variables and perioperative indicators were collected to evaluate surgical outcomes in both groups.</p> Results <p>Postoperative statistics indicated that the operation time for the MR group was significantly shorter than that of the control group (102.00(98.00 103.00) minutes vs. 103.50(101.00 106.75) minutes, p = 0.017). The estimated intraoperative blood loss was also lower in the MR group compared to the control group (58.50(53.00 63.00) ml vs. 77.00(72.00 86.00) ml, p &lt; 0.001). Additionally, the recovery time for gastrointestinal function in the MR group was significantly shorter than that in the control group (28.00(26.00 30.00) hours vs. 32.00(30.00 35.00) hours, p &lt; 0.001). While there was no significant difference in the incidence of postoperative complications between the two groups, the postoperative hospitalization duration for patients in the MR group was significantly shorter (4.00(4.00 5.00) days vs. 5.00(5.00 5.00), p = 0.004). No statistically significant difference was observed in the spectrum of potential adrenal diseases between the MR and control groups (p &gt; 0.05).</p> Conclusion <p>Compared to traditional CT imaging, RALPA guided by mixed reality technology may be associated with a modest reduction in surgical time, a decrease in intraoperative blood loss, and faster recovery of gastrointestinal function. However, the clinical significance of these observed differences remains limited, and the findings should be interpreted cautiously due to the retrospective study design. Prospective controlled studies are needed to confirm whether MR technology provides a true clinical advantage over conventional imaging in adrenal surgery.</p>