Does Robotic Adrenalectomy Outperform Laparoscopic Approaches in Obese Patients? A Systematic Review and Subgroup Meta-Analysis of 1,107 Patients.

BACKGROUND

Obesity poses technical challenges in adrenalectomy. Robotic adrenalectomy (RA) offers advantages over laparoscopic adrenalectomy (LA), but evidence in obese patients remains limited.

METHODS

A meta-analysis of comparative studies through 2025 assessed perioperative outcomes of RA versus LA, with subgroup analyses by body habitus (obese vs. non-obese) and surgical approach (lateral transabdominal [LT] vs. posterior retroperitoneal [PR]). Primary outcomes included operative time (OT), blood loss (EBL), hospital stay (LOHS), complications, conversion, and mortality. Study quality was evaluated using the Newcastle-Ottawa Scale, and certainty was assessed using the GRADE approach.

RESULTS

Eight studies (1107 patients) were included. RA was associated with reduced EBL (p < 0.001) and shorter LOHS (p < 0.001), with no other significant differences. Subgroup analysis showed shorter LOHS in non-obese LA patients (p = 0.03). PR showed a shorter LOHS (p = 0.001) compared with LT.

CONCLUSIONS

RA provides perioperative benefits, particularly reduced blood loss and shorter hospital stay, without compromising safety.