Laparoscopic Versus Robotic Adrenalectomy: A Randomized Clinical Trial

Abstract Background This study aimed to compare perioperative outcomes between laparoscopic and robotic transabdominal lateral adrenalectomies. Background Despite growing interest in robotic adrenalectomy (RA), its benefits compared with those for laparoscopic adrenalectomy (LA) need to be identified. Two previously published randomized studies used out-of-date technologies and included only pheochromocytoma patients, respectively. Methods A prospective randomized clinical trial was conducted by a single surgeon between May 2024 and February 2025. Patients with adrenal tumors eligible for minimally invasive lateral transabdominal adrenalectomy were randomized to LA or RA. The trial was powered to detect a 30-min difference in operative time. The secondary outcomes were perioperative outcomes, cost, and ergonomics, measured by the NASA Task Load Index (NASA-TLX) and the Rapid Upper Limb Assessment (RULA). Results In the study, 27 patients were randomized to each group. The groups were similar in demographics, clinical characteristics, and operative indications. The operative times and secondary outcomes were similar between the groups except that the RA group had a lower median operating surgeon NASA-TLX score (16 vs 48; P ≤ 0.001) and a lower overall RULA score (14 vs 17; P = 0.001) than the LA group. Operation room, hospital, and total costs were similar between the groups. Although all the procedures were completed as planned in the RA group, the LA group had four conversions from the original minimally invasive plan (conversion to open, hand-assisted procedure, and partial adrenalectomy and abortion of the procedure in one patient each). Conclusions Perioperative outcomes, including cost, were similar between LA and RA, with better ergonomics and fewer conversions from the original minimally invasive surgical plan in the RA group.