Minimally Invasive Techniques in Adrenal Surgery

Minimally invasive approaches to adrenalectomy have revolutionised the management of adrenal pathology by reducing patient morbidity, shortening hospital stay and improving postoperative recovery. Laparoscopic adrenalectomy, whether via a transperitoneal or retroperitoneal route, has become the standard for benign and small-to-medium adrenal masses. The transperitoneal approach offers a wider working space and familiar anatomy for most surgeons, while the retroperitoneal route minimises intra-abdominal organ manipulation and may be preferred in high-body-mass-index patients or when addressing bilateral lesions. Robotic systems have been introduced to enhance three-dimensional vision, improve instrument dexterity and facilitate complex dissection in confined retroperitoneal spaces. Comparative evaluations have demonstrated that robotic adrenalectomy can lower intraoperative blood loss and accelerate gastrointestinal recovery, albeit often at the expense of longer operative and docking times and higher costs. Emerging platforms and tailored selection of access routes based on tumour characteristics, patient anatomy and institutional expertise are driving further refinement of minimally invasive adrenal surgery.

Research from Nature Portfolio

Recent studies have evaluated the safety profile and learning curve of robotic adrenalectomy over extended institutional experience. Data from more than a decade of cases reveal a consistent decline in mean operative times as teams accrue proficiency, with female patients and those harbouring small tumours demonstrating shorter procedures. Pheochromocytomas emerge as an independent predictor of prolonged console time, underscoring the need for meticulous haemodynamic control. Importantly, no significant perioperative complications were reported across large series, confirming that robotic adrenalectomy is a safe, effective alternative to standard laparoscopy and offers reproducible outcomes when performed in high-volume settings.

Minimally Invasive Techniques in Adrenal Surgery publication trend

The graph below shows the total number of articles in minimally invasive techniques in adrenal surgery across all publications each year (not limited to Nature Index journals).

Technical terms

Laparoscopic adrenalectomy: Minimally invasive removal of the adrenal gland using small abdominal incisions and a video camera.

Transperitoneal approach: Entry into the peritoneal cavity for adrenalectomy, providing a broad operative field and familiar landmarks.

Retroperitoneal approach: Direct access to the adrenal gland through the back or flank without traversing the peritoneal cavity, reducing visceral manipulation.

Robotic adrenalectomy: Use of a robotic platform to perform adrenal gland removal, enhancing vision and instrument articulation in confined spaces.

References

1. Robotic-assisted laparoscopic adrenalectomy (RARLA): What advantages and disadvantages compared to retroperitoneal laparoscopic adrenalectomy (RLA)?. Frontiers in Endocrinology (2023).
2. Safety and surgical outcomes of robotic adrenalectomy from a 15-year experience at a single institution. Scientific Reports (2024).
3. Laparoscopic Adrenalectomy: Tailoring Approaches for the Optimal Resection of Adrenal Tumors. Diagnostics (2023).
4. Innovation in endocrine surgery: robotic versus laparoscopic adrenalectomy. Meta-analysis and systematic literature review. Oncotarget (2017).
5. Systematic Review of Surgical Approaches for Adrenal Tumors: Lateral Transperitoneal versus Posterior Retroperitoneal and Laparoscopic versus Robotic Adrenalectomy. International Journal of Endocrinology (2014).
6. Comparison of the retroperitoneal versus Transperitoneal laparoscopic Adrenalectomy perioperative outcomes and safety for Pheochromocytoma: a meta-analysis. BMC Surgery (2020).