Urology NSW
Robotic Adrenalectomy

What is Robotic Adrenalectomy?

Robotic adrenalectomy is a minimally invasive surgical procedure to remove one or both adrenal glands using the da Vinci robotic surgical system. The adrenal glands are small, triangular-shaped glands located on top of each kidney that produce essential hormones including cortisol, aldosterone, and adrenaline.


This advanced surgical technique offers significant advantages over traditional open surgery, including smaller incisions, reduced blood loss, less post-operative pain, shorter hospital stays, and faster recovery times.1


Adrenal Masses and Tumours

Adrenal masses are growths that develop on the adrenal glands. They can be benign (non-cancerous) or malignant (cancerous), and may be functioning (hormone-producing) or non-functioning.2


Common Types of Adrenal Masses Include:

  • Adrenal adenomas - Benign tumours that may produce excess hormones
  • Phaeochromocytoma - Tumours that produce excess adrenaline and noradrenaline
  • Aldosteronoma - Tumours causing primary hyperaldosteronism (Conn's syndrome)
  • Adrenocortical carcinoma - Rare malignant tumours of the adrenal cortex
  • Adrenal metastases - Secondary cancers that have spread from other sites
  • Incidentalomas - Adrenal masses discovered incidentally during imaging for other conditions

Indications for Robotic Adrenalectomy

Surgical removal of adrenal masses is recommended in the following situations:3

  • Functioning tumours causing hormonal excess (e.g., Cushing's syndrome, Conn's syndrome, phaeochromocytoma)
  • Adrenal masses larger than 4cm with concerning imaging characteristics
  • Suspected adrenal malignancy
  • Growing adrenal masses on serial imaging
  • Symptomatic adrenal masses

Benefits of Robotic Adrenalectomy

The robotic approach to adrenalectomy has become the gold standard for most adrenal tumours due to its numerous advantages:4,5

  • Enhanced visualisation - 10x magnification with 3D high-definition view
  • Superior precision - Robotic instruments have greater range of motion than the human wrist
  • Minimal scarring - Small keyhole incisions (typically 8-12mm)
  • Reduced blood loss - Precise dissection minimises bleeding
  • Less post-operative pain - Smaller incisions mean less tissue trauma
  • Shorter hospital stay - Most patients go home within 1-2 days
  • Faster recovery - Return to normal activities within 2-3 weeks

The Robotic Adrenalectomy Procedure

The procedure is performed under general anaesthesia. Small incisions are made in the abdomen, and the da Vinci robotic system is used to carefully dissect around the adrenal gland, identifying and preserving important blood vessels and surrounding structures.


The surgeon controls the robotic arms from a console, which provides a magnified, three-dimensional view of the operative field. The adrenal gland is carefully separated from the kidney and surrounding tissues, the blood supply is controlled, and the gland is removed through one of the small incisions.


For phaeochromocytomas, special anaesthetic precautions are taken to manage blood pressure fluctuations during the procedure.6


Recovery After Robotic Adrenalectomy

Most patients experience a straightforward recovery following robotic adrenalectomy:

  • Hospital stay: 1-2 days
  • Return to light activities: 1-2 weeks
  • Return to normal activities: 2-3 weeks
  • Return to work: 2-4 weeks (depending on occupation)

Following removal of a functioning tumour, patients often notice immediate improvement in their symptoms as hormone levels normalise. Some patients may require temporary hormone replacement therapy.7


Outcomes and Success Rates

Robotic adrenalectomy has excellent outcomes with low complication rates. Studies have shown comparable oncological outcomes to open surgery with significantly reduced morbidity.8 The conversion rate to open surgery is low (less than 5% in experienced centres), and major complications are rare.


For functioning tumours, biochemical cure rates are excellent, with the majority of patients achieving normalisation of hormone levels following surgery.9

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References

  1. Stefano Giordano, Johanna Paivaoja, Terhi Rouhia, et al. - Robot-assisted versus open adrenalectomy: A systematic review and meta-analysis. European Journal of Surgical Oncology. 2024;50(6):108244. https://doi.org/10.1016/j.ejso.2024.108244
  2. Grumbach MM, Biller BM, Braunstein GD, et al. - Management of the clinically inapparent adrenal mass ("incidentaloma"). Ann Intern Med. 2003;138(5):424-429. doi:10.7326/0003-4819-138-5-200303040-00013
  3. Fassnacht M, Arlt W, Bancos I, et al. - Management of adrenal incidentalomas: European Society of Endocrinology Clinical Practice Guideline. Eur J Endocrinol. 2016;175(2):G1-G34. doi:10.1530/EJE-16-0467
  4. Brandao LF, Autorino R, Laydner H, et al. - Robotic versus laparoscopic adrenalectomy: a systematic review and meta-analysis. Eur Urol. 2014;65(6):1154-1161. doi:10.1016/j.eururo.2013.09.021
  5. Morelli L, Tartaglia D, Bronzoni J, et al. - Robotic assisted versus pure laparoscopic surgery of the adrenal glands: a case-control study comparing surgical techniques. Langenbecks Arch Surg. 2016;401(7):999-1006. doi:10.1007/s00423-016-1494-0
  6. Lenders JW, Duh QY, Eisenhofer G, et al. - Pheochromocytoma and paraganglioma: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2014;99(6):1915-1942. doi:10.1210/jc.2014-1498
  7. Bancos I, Alahdab F, Crowley RK, et al. - Therapy of Endocrine Disease: Improvement of cardiovascular risk factors after adrenalectomy in patients with adrenal tumors and subclinical Cushing's syndrome. Eur J Endocrinol. 2016;175(6):R283-R295. doi:10.1530/EJE-16-0411
  8. Agrusa A, Romano G, Frazzetta G, et al. - Laparoscopic adrenalectomy for large adrenal masses: single team experience. Int J Surg. 2014;12 Suppl 1:S72-S74. doi:10.1016/j.ijsu.2014.05.050
  9. Young WF Jr. - The incidentally discovered adrenal mass. N Engl J Med. 2007;356(6):601-610. doi:10.1056/NEJMcp065470