Robotic adrenalectomy achieves shorter operative time than laparoscopic approach: a propensity score-matched analysis

Robotic adrenalectomy (RA) offers advantages over conventional laparoscopic adrenalectomy (LA), including enhanced visualization and instrument articulation. However, comparative data on operative efficiency in Japan remain limited, particularly during the early adoption phases. This study aimed to compare the operative times between RA and LA using propensity score-matched analysis while evaluating the feasibility of a reduced-port RA technique. We conducted a single-center retrospective cohort study of 255 patients who underwent adrenalectomies between January 2010 and May 2025. The patients were grouped according to the surgical approach (RA vs. LA). The data collected included demographics, tumor characteristics, operative details, and complications. The primary outcomes were operative time and duration of pneumoperitoneum. Multivariate regression was used to identify predictors of prolonged time. Propensity score matching was controlled for confounders, including age, body mass index (BMI), American Society of Anesthesiologists-Physical Status classification (ASA-PS), tumor size, tumor histology, and surgeon's experience. Patients with RA had slightly larger tumors but experienced significantly shorter operative (median, 131 min vs. 168 min, p < 0.001) and insufflation times (95 min vs. 138 min, p < 0.001) than those with LA. Multivariate analysis confirmed RA as an independent predictor of reduced times (operative: - 22.26 min; insufflation: - 21.82 min; both p < 0.001), while tumor size ≥ 40 mm and pheochromocytoma independently prolonged times. After matching (n = 53 pairs), the RA remained significantly faster. In conclusion, RA achieves significantly shorter operative and insufflation times than LA even during its early adoption phase. A three-port RA approach is feasible without increasing complications, and reduced-port RA may further enhance operative efficiency while maintaining safety.