Comparative Analysis of Robotic, Laparoscopic, and Open Adrenalectomies for Pheochromocytomas

Abstract

Background: This study compared outcomes of robotic adrenalectomy (RA), laparoscopic adrenalectomy (LA), and open adrenalectomy (OA) for phaeochromocytoma, focusing on intraoperative haemodynamic stability and perioperative results.

Methods: We conducted a retrospective cohort study at a single tertiary referral centre (2019–2024). All consecutive adults undergoing RA, LA, or OA for phaeochromocytoma were included. RA was performed with the Da Vinci Xi system after programme establishment. The surgical approach was selected by the consultant surgeon according to tumour characteristics and patient factors; OA was generally reserved for suspected malignancy or tumours >10 cm. Diagnosis was confirmed preoperatively with plasma and/or urinary catecholamines. The primary outcome was haemodynamic stability, assessed as the intraoperative mean arterial pressure (MAP) variability (maximum–minimum). Secondary outcomes included operating time, conversion, length of stay (LOS), complications (Clavien–Dindo), and transfusion. Standard statistical tests were applied with two-sided significance set at 0.05.

Results: Sixty-four patients were included (RA=21, LA=38, OA=5). Mean MAP variability was lower with RA than LA (40.3 vs 50. mmHg; p=0.064) and similar to OA (37.9mmHg). RA had the shortest operating time (61.3 ± 31.4min) compared with LA (104.2 ± 36.0min) and OA (187.9 ± 102.0min; p<0.001). Conversion occurred in 5% of RA and 3% of LA cases. LOS was shorter after RA (1.81 days) than LA (3.67 days; p<0.05) and OA (8.80 days; p<0.05). Complication rates were 5% (RA), 8% (LA), and 43% (OA; p=0.015). Transfusion was required in 0% (RA), 2.6% (LA), and 40% (OA; p=0.001).

Conclusions: Robotic adrenalectomy using the Da Vinci Xi system was associated with shorter operating time, reduced hospital stay, and fewer complications than laparoscopic and open surgery. Although the difference in haemodynamic stability did not reach statistical significance, RA showed a favourable trend and no transfusion requirement, supporting its safe and effective use for phaeochromocytoma in appropriately selected patients.