Robotic vs. Laparoscopic Adrenalectomy for Pheochromocytoma-A Systematic Review and Meta-Analysis

Background: The application of robotic adrenalectomy (RA) has been increasing. However, there is still controversy about whether RA is more feasible than laparoscopic adrenalectomy (LA) for pheochromocytoma (PHEO). Methods: We conducted a systematic review of published articles between 2013 and 2025 according to the PRISMA statement and the Cochrane Handbook for systematic reviews of interventions. The search was conducted in MEDLINE (PubMed, Scholar, and Cochrane databases). Results: Overall, seven studies including 879 patients (RA 358; LA 521) were included. RA might have larger tumor size (MD -0.66, 95% CI -1.18 to 0.13; p < 0.00001) but not for BMI patients (MD -0.24, 95% CI -1.44 to 0.96; p < 0.00001). There were no statistically significant differences in intraoperative complication, conversion to open surgery, postoperative complications, transfusion rate, and perioperative hemodynamic outcomes with the exception of a higher lowest systolic blood pressure in the LA group (MD -1.09, 95% CI -2.35 to 0.18; p < 0.00001). Moreover, estimated blood loss (MD 29.52, 95% CI 4.19 to 54.84; p < 0.00001), operative time (MD 3.85, 95% CI -16.11 to 23.80; p < 0.00001), and the length of hospital stay were in favor of RA (MD 0.42, 95% CI 0.09 to 0.74; p < 0.0001). Conclusions: Both LA and RA are safe and feasible approaches for adrenalectomy in the case of pheochromocytoma. RA seems to have better perioperative results, but further prospective randomized control studies are required to draw definitive conclusions.