Laparoscopic vs. Robotic transabdominal adrenalectomy- propensity matched analysis and learning curve.

Background: While laparoscopic transabdominal or retroperitoneal adrenalectomy is standard care for adrenal tumors, benefits of robotic adrenalectomy (RA) are yet unclear. We evaluated the costs (including disposables), outcomes as well as the learning curve of robotic and laparoscopic adrenalectomy (LA) in a specialized center.

Methods: In retrospective analysis of our prospective database (ethical approval number 88/11) 263 LA were compared to 27 RA in the study period between 2018 and 2023. A propensity score match analysis was used to exclude possible confounders. Furthermore, the learning curve of RA was investigated.

Results: Intraoperative Riva Rocci (RR) fluctuations (> 160mmHg, < 90 mmHg), early complications (within 30 days) and intraoperative blood loss were comparable in both groups. However, length of stay was decreased following robotic adrenalectomy (3.50d ± 1.81d compared to 4.61d ± 2.75d; p = 0.04). Due to this, overall costs of RA were lower compared to LA even if cost for disposables were slightly higher in the robotic group. An analysis of the learning curve of robotic adrenalectomy revealed that learning curve is completed after 5- 6th procedure.

Conclusions: Taken together our study supports the fact that RA is as secure and feasible as LA. Furthermore, it might provide advantages due to shorter length of stay, a short learning curve and similar costs compared to LA.