Contemporary Practice in Adrenal Surgery: A Review of Multiport versus Single-port and Transperitoneal versus Retroperitoneal Approaches.

Robotic adrenalectomy has emerged as the preferred approach for adrenal gland surgery because of its greater precision, better ergonomics, good safety profile, and minimally invasive nature. There is ongoing debate over the optimal surgical approach, specifically regarding multiport versus single-port platforms, and transperitoneal versus retroperitoneal access. Multiport robotic adrenalectomy remains the standard because of its familiarity and wider surgical exposure, whereas single-port surgery offers the advantage of better cosmesis and lower incision-related morbidity despite a more challenging learning curve. The transperitoneal approach provides familiar and superior anatomic visibility and working space, while the retroperitoneal approach avoids intra-abdominal dissection, reduces postoperative ileus, and may be preferable in selected patients. This review summarises the advantages and limitations of each technique to inform surgical decision-making. PATIENT SUMMARY: This review compares ways of performing keyhole surgery on the adrenal gland. Keyhole surgery using multiple small incisions has been more common because of the ease of use and familiarity, while keyhole surgery using a single incision has better cosmetic results but is more difficult. Accessing the adrenal gland through the abdomen (transperitoneal access) provides better visibility, whereas access by avoiding the abdomen (retroperitoneal access) allows faster patient recovery after surgery.