Robotic adrenalectomy: a comprehensive review of perioperative outcomes, comparative efficacy, and technological advancements.

The adrenal glands are small but vital endocrine organs responsible for hormone production, which is essential for stress response, fluid balance, and blood pressure regulation. Adrenalectomy, the surgical removal of one or both adrenal glands, is indicated in various benign and malignant conditions such as pheochromocytomas, aldosterone-producing adenomas, and adrenocortical carcinoma. Historically performed via open surgery, adrenalectomy has evolved significantly with the introduction of laparoscopic adrenalectomy in the 1990s and more recently, robotic adrenalectomy. Robotic adrenalectomy enhances surgical precision through 3D visualization, articulated instruments, and improved ergonomics, thereby addressing the limitations inherent to laparoscopic adrenalectomy. This narrative review synthesises the findings from pivotal studies that compare the perioperative outcomes of robotic adrenalectomy and laparoscopic adrenalectomy. Robotic adrenalectomy demonstrates favourable outcomes in terms of operative precision, reduced estimated blood loss, and comparable or shorter hospital stay, especially in complex scenarios involving obesity, large tumours, or altered anatomy. Complication rates remain low, and R0 resection rates exceed 95% in well-selected malignancies, supporting the oncological adequacy of robotic adrenalectomies. While robotic adrenalectomy offers superior surgeon ergonomics and a relatively short learning curve, its high initial costs and lack of tactile feedback present notable limitations. Technological advancements, including high-definition 3D optics, fluorescence imaging, and artificial intelligence integration, have further refined the potential of robotic adrenalectomies. However, the evidence remains largely retrospective, with limited prospective randomised trials evaluating long-term outcomes and cost-effectiveness. Robotic adrenalectomy appears to be particularly advantageous in complex adrenal cases, offering a safe, minimally invasive option with the potential for improved recovery and surgical outcomes. Future research should focus on the long-term oncologic efficacy, patient-reported outcomes, and economic sustainability of robotic adrenalectomy in diverse clinical settings. Robotic adrenalectomy represents a significant milestone in adrenal surgery, with growing evidence supporting its selective use as a preferred approach in experienced centres and in appropriately chosen patients.