Robotic adrenalectomy

When it is used

The robotic approach is used for most adrenal tumours that are suitable for minimally invasive removal, including:³

• Functioning tumours causing hormonal excess - Cushing's syndrome, Conn's syndrome, phaeochromocytoma.
• Adrenal masses larger than about 4 cm with concerning imaging characteristics.
• Suspected malignancy that can still be removed completely with an intact capsule.
• Growing adrenal masses on serial imaging.
• Symptomatic adrenal masses.

How the operation is done

The procedure is performed under general anaesthesia. Four or five small keyhole incisions are placed in the side or upper abdomen. The da Vinci arms are docked to the ports, and the surgeon operates from a console that provides a magnified, three-dimensional view of the operative field.

Key surgical steps:

• Gentle retraction of the liver (on the right) or spleen and pancreas tail (on the left) to expose the adrenal gland.
• Early identification and ligation of the adrenal vein, particularly important in phaeochromocytoma to limit catecholamine release.
• Dissection around the gland, preserving the kidney and surrounding structures.
• Removal of the gland through one of the small incisions in a retrieval bag.

For phaeochromocytomas, the anaesthetic team uses invasive monitoring and is prepared to manage blood pressure swings during and after the operation.⁶

Benefits compared with open surgery

Published systematic reviews and meta-analyses comparing robotic with open or laparoscopic adrenalectomy have shown, on average:^1,4,5

• Smaller incisions (typically 8 to 12 mm).
• Reduced blood loss.
• Less post-operative pain.
• Shorter hospital stays.
• Faster return to normal activities.
• Oncological outcomes comparable to open surgery in appropriately selected tumours.

The robotic system adds wristed instruments and a 3D magnified view compared with conventional laparoscopy; the real-world advantage depends on surgeon experience and centre volume.

Recovery

Most patients follow a straightforward recovery path:

• Hospital stay: 1 to 2 days.
• Return to light activities: 1 to 2 weeks.
• Return to normal activities: 2 to 3 weeks.
• Return to work: 2 to 4 weeks, depending on the occupation.

After removal of a functioning tumour, patients often notice rapid improvement in symptoms as hormone levels normalise. Some patients - particularly after long-standing cortisol excess - need temporary steroid replacement until the opposite gland recovers.⁷ See what to expect for more detail.

Risks

Every operation carries risk. Specific to adrenalectomy, these include:

• Bleeding, given the gland's rich blood supply. Major bleeding is uncommon with modern technique.
• Injury to adjacent structures (liver, spleen, pancreas, kidney, bowel, diaphragm).
• Conversion to open surgery, for safety. Reported conversion rates in experienced centres are low (generally under 5%).¹
• Wound infection, chest infection and thromboembolism, as with any abdominal operation.
• Blood pressure swings during phaeochromocytoma surgery despite careful preparation.
• Adrenal insufficiency after surgery for cortisol-producing tumours, requiring steroid cover until the opposite gland recovers.

These are discussed in detail at the pre-operative consultation, in the context of your own scans and health.

Outcomes and published evidence

A recent systematic review and meta-analysis comparing robot-assisted with open adrenalectomy concluded that robotic adrenalectomy reduces blood loss and length of stay without worsening oncological outcomes in appropriately selected patients.¹ Comparisons with conventional laparoscopic adrenalectomy show comparable oncological outcomes and small reductions in conversion rates and length of stay.^4,5 Full reference list is on the outcomes page.