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

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.