Robot-Assisted Single and Multiport Adrenalectomy

Laparoscopic technology has presented new frontiers to adrenal surgery thus enabling modification and refinement of established conventional procedures. The integration of robotic surgery has made it feasible to offer alternatives to patients requiring surgical treatment of both benign and malignant adrenal disorders. Robotic assistance may allow more surgeons with limited conventional laparoscopic experience to offer to their patients a minimally invasive approach. Indications for robotic adrenalectomy mirror those of laparoscopic adrenalectomy and include most adrenal tumors, except those concerning adrenocortical carcinoma, which in some cases may be approached with open surgery if large or concerning for local invasion. Surgical approach (transperitoneal or retroperitoneal) is determined by surgical goals, the patient’s medical and surgical history, and surgeon experience. A systematic review and a meta-analysis of current evidence show that robot-assisted adrenalectomy can be performed safely and effectively with comparable operative times and complication rates to laparoscopic adrenalectomy. In addition, a robotic approach can provide the potential advantage of a shorter hospital stay and less blood loss. These findings seem to support the use of robotic surgery for the minimally invasive surgical management of adrenal masses.