This study was conducted to better understand the challenges of minimally invasive adrenalectomies and guide surgeons in choosing the adrenalectomy approach.

Patients who underwent minimally invasive lateral transabdominal adrenalectomy between April 2012 and January 2023 were retrospectively analyzed and divided into two main groups: Laparoscopic Adrenalectomy (LA) and Robotic Adrenalectomy (RA). Two groups were compared regarding demographics, lesion characteristics, operative time, intraoperative blood loss, conversion rate, intraoperative and postoperative complications, and hospital stay. Also, the RA patients were divided into subgroups according to hormonal status, malignancy, histopathology, and tumor size (≤ 4 cm, 4-6 cm, >6 cm). The LA and RA groups were compared. RA subgroups were compared within themselves.

Data was collected from 218 patients [LA group (n=129) and RA group (n=89)]. Regarding outcomes, there was no difference between RA and LA groups, except for operation time (in favor of LA, 115.67 vs. 130.43 min, p= 0.01). In the RA subgroups, the amount of intraoperative blood loss varied significantly between the lesion size groups (p=0.01), and a positive correlation was found between lesion size and intraoperative blood loss. Pairwise comparison revealed a significant difference between ≤ 4cm and 4-6 cm groups (p=0.002). Although intraoperative complications and conversion rate in the > 6cm lesion group were higher than in smaller lesion groups, the difference was insignificant (p=0.073 vs. p=0.054).

The increase in complications and conversion rates correlated with the lesion size should be considered by surgeons when choosing the adrenalectomy technique.