Robotic versus laparoscopic adrenalectomy: a propensity-score matched retrospective study

Laparoscopic adrenalectomy is the standard minimally invasive approach for adrenal tumors, and robotic-assisted surgery has increasingly been adopted as an alternative. Comparative studies have not consistently demonstrated superiority of either technique, and most are limited by confounding by indication, as robotic programs are introduced after laparoscopic practice is already established. We compared perioperative outcomes between robotic and laparoscopic adrenalectomy at a single center using propensity-score matching to reduce this confounding.

This retrospective, single-center study included all consecutive patients undergoing laparoscopic or robotic transabdominal adrenalectomy between May 2021 and March 2026 (n = 96; 58 laparoscopic, 38 robotic), after excluding 19 patients with a non-minimally invasive approach from the outset. Patients were matched 1:1 by nearest-neighbor propensity-score matching (caliper 0.2 standard deviations of the logit propensity score) on age, sex, body mass index, ASA class, tumor size, and functional status. Calendar year of surgery was not included in the matching model, owing to quasi-complete separation, but was assessed for balance and addressed in a sensitivity analysis. Continuous outcomes were compared using the paired Wilcoxon signed-rank test and binary outcomes using McNemar's test.

Matching yielded 35 pairs (70 patients), well balanced on all matched covariates (standardized mean difference ≤ 0.12). Operative time did not differ significantly between groups (median 105 versus 95 min, p = 0.174). Length of hospital stay was shorter with the robotic approach in the unadjusted analysis (p = 0.026), but this difference was no longer significant after adjusting for calendar year of surgery (p = 0.391). Rates of vasopressor use, transfusion, intraoperative and postoperative complications, conversion to open surgery, and readmission were low (0-3 events per group) and did not differ significantly between groups. One death occurred in the matched cohort (robotic group), related to progression of metastatic disease rather than surgery.

Our findings are broadly consistent with recent comparative and propensity-matched studies showing similar perioperative safety profiles for robotic and laparoscopic adrenalectomy. The attenuation of the length-of-stay difference after adjusting for calendar year illustrates the risk of attributing temporal trends in perioperative care to the surgical approach itself, a consideration relevant to any single-center comparison spanning the introduction of a new surgical platform.

In this propensity-score matched cohort, robotic and laparoscopic adrenalectomy showed comparable perioperative outcomes, without clear superiority of either approach. Larger, multicenter studies are needed to confirm these findings, particularly for infrequent outcomes.