Evaluating Patient Safety and Efficacy of Robot-Assisted Adrenalectomy: 90-Day Outcomes

To evaluate the 90-day safety and efficacy of robot-assisted adrenalectomy (RAA) at a tertiary care centre in a low- and middle-income country, with a focus on the correlation between tumour histopathology and perioperative outcomes, learning curve, and technical aspects.

An observational study. Place and Duration of the Study: Department of Urology, Sindh Institute of Medical Science/Sindh Institute of Urology and Transplantation, Karachi, Pakistan, from January 2022 to December 2024.

Patients were stratified into malignant and benign pathology groups. Data included demographics, perioperative outcomes, and 90-day follow-up. Distribution was tested using the Shapiro-Wilk. Non-parametric continuous variables were analysed using the Mann-Whitney U and Kruskal-Wallis tests; categorical variables using the chi-square or Fisher's exact test. Learning-curve performance was assessed by Jonckheere-Terpstra trend testing and 20-case block analysis.

Malignant tumours were associated with significantly longer operative time (150 min vs. 90 min; p = 0.005) and higher need for intraoperative pack placement (16.7% vs. 0%; p = 0.003). Conversion to open surgery was significantly higher in malignant cases (16.7% vs. 3.9%; p = 0.012). Postoperative creatinine was significantly elevated in malignant tumours (0.93 ± 0.35 vs. 0.69 ± 0.20 mg/dL; p = 0.017). Estimated blood loss (EBL) was higher in malignant lesions (300 mL vs. 150 mL), although not statistically significant (p = 0.053). Length of hospital stay, postoperative complications, 90-day readmission, and mortality were similar between the groups, and no readmissions, complications, or deaths occurred during the follow-up period. Functional benefit was greater in patients with benign tumours, with discontinuation of antihypertensive medications occurring significantly more frequently (51.3%; p = 0.034). Learning-curve assessment showed no significant monotonic improvement in operative time (p = 0.820) or EBL (p = 0.478), and block-wise trends demonstrated clinically stable perioperative performance.

RAA is a safe and effective approach for both benign and malignant adrenal disease, demonstrating acceptable complication rates and stable learning-curve performance. These findings support its feasibility and safe integration even within developing healthcare systems.

Robot-assisted adrenalectomy, Adrenal tumour, Perioperative outcomes, Learning curve, Operative time.