The quality and safety of establishing Ireland's first robotic adrenalectomy program: a single centre experience

Robotic adrenalectomy offers several technical advantages over conventional laparoscopy, particularly for lesions located adjacent to major vascular structures. However, data regarding the establishment of new robotic adrenalectomy programmes remains limited. This study aimed to evaluate the safety, feasibility, and early outcomes of implementing the first robotic adrenalectomy programme in the Republic of Ireland.

A retrospective review of the first 50 consecutive patients who underwent robotic adrenalectomy between November 2021 and December 2024 at a tertiary endocrine surgery referral centre was performed. Clinical, pathological, and perioperative outcomes were analysed. Continuous variables were compared using Student's t-test or Mann-Whitney U test, and multivariable linear regression was used to assess factors associated with operative duration.

The mean age was 58.3 years, and 72% of patients were male. Median body mass index was 29.1 kg/m². The most common indications for surgery were phaeochromocytoma (32%), Cushing's syndrome (22%), and non-functioning lesions (18%). Median operative duration was 120 min (range 80-210). Conversion to open surgery occurred in 1 patient (2%), and intraoperative complications occurred in 3 patients (6%). Mean length of stay was 4.0 days. Postoperative morbidity was low, with four Clavien-Dindo grade II complications and one grade IIIa complication. There were no 30-day mortalities, reoperations, or readmissions. Complete (R0) resection was achieved in 94% of cases. Patients with larger tumours had longer operative duration and length of stay, whereas elevated BMI was not associated with increased operative duration.

Robotic adrenalectomy is a safe and feasible minimally invasive approach that can be successfully implemented within a tertiary referral endocrine surgery centre, with low morbidity, low conversion rates, and acceptable pathological outcomes.