Single-port robot-assisted adrenalectomy: technical considerations and a single-center experience

To describe the surgical technique, report our initial experience with single-port robot-assisted adrenalectomy (SP-RA), and evaluate technical considerations.

We retrospectively reviewed patients who underwent SP-RA between January 2021 and January 2026. Preoperative workup included biochemical testing and cross-sectional imaging. All procedures were performed by a single surgeon using the da Vinci SP® system. Early cases were transperitoneal, followed by a transition to a retroperitoneal approach. Demographic, clinical, operative, and postoperative outcomes were analyzed. Continuous variables are reported as medians and categorical variables as percentages. Associations with operative time were assessed using Spearman's correlation.

Twenty-three patients underwent SP-RA. Median age was 54 years (IQR 40-70) and median BMI 28.9 kg/m² (IQR 25.6-34.1). Functioning tumors were present in 60.9%. The retroperitoneal approach was used in 82.6%. Median operative time was 154 min (IQR 137-174) and blood loss 20 mL (IQR 10-20). 52.2% of patient were discharged on the same day and the mean length of stay was 29.1 ± 45.5 h, with one patient (4.3%) requiring opioids at discharge. One intraoperative complication (4.3%) and five post-operative complications (21.7%) occurred (median 7 days). Final pathology was predominantly benign, with cortical adenoma representing the most common diagnosis (60.9%). No variables were significantly associated with operative time, though a trend favored left-sided cases (ρ = -0.35, p = 0.09).

SP-RA via a supine anterior retroperitoneal approach is safe and feasible, with minimal blood loss and short hospitalization, often enabling outpatient management.