Robotic Adrenalectomy: Robotic (Robot-Assisted) Adrenal Surgery

What is Robotic Adrenal Surgery?

Robotic adrenal surgery (also called robotic or robot-assisted adrenalectomy) is a surgical technique in which the surgeon uses a "surgical robot" to assist in the dissection and removal of an adrenal gland. It is often performed by surgeons who use the robot for other operations (like the prostate or kidney) and have adapted the technique for adrenal operations. It can be done well by an experienced team; the surgeon's experience with adrenal surgery matters more than the tool.

The robotic (robot-assisted) adrenalectomy approach is similar to the laparoscopic trans-abdominal adrenalectomy (LTA) discussed as number 2 on the "8 Types of Adrenal Surgery" page, except that in the LTA the surgeon holds the instruments in his or her hands, and in the robot-assisted operation the instruments are held by a machine (the "robot") while the surgeon controls them from a console in the operating room. Most robotic adrenalectomies, like most laparoscopic adrenalectomies, are performed through the front or side of the abdomen, with the instruments working past the abdominal organs (bowel, stomach, spleen, liver, pancreas, etc.) to get to the adrenal gland, which lies in the back behind all of them. The robot can also be used through the back, but this is less common.

Why do we prefer the back approach to laparoscopic and robotic adrenalectomy through the belly? Read more on our adrenal surgery blog

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Does the Carling Adrenal Center Perform Robotic Adrenal Surgery?

No. Dr. Carling is one of the world's most experienced adrenal surgeons, performing up to 750 adrenal operations a year. While he was the Chief of Endocrine Surgery at Yale University, he had the opportunity to evaluate robotic adrenal surgery. After performing quite a few, he concluded that for most patients it is not as good an approach to the adrenal glands as the Mini Back Scope Adrenalectomy (MBSA), and he stopped using the robot for adrenal surgery in about 2010. Other experienced adrenal surgeons have reached a different conclusion, and robotic adrenalectomy has become more common since then. We remain convinced that a direct back approach with standard instruments is the better operation for most adrenal tumors.

What we see as the problems with robotic adrenal surgery. In our view, the robot adds operating time and expense without proven benefit. Setting up and docking the robot adds time under general anesthesia, and a robotic adrenalectomy typically takes 3 to 5 hours (a laparoscopic adrenalectomy 2 to 4 hours), considerably longer than an MBSA, which typically takes Dr. Carling about 20 minutes. Longer time under general anesthesia is associated with a higher risk of nausea and vomiting after surgery. Studies comparing robotic with standard laparoscopic adrenalectomy show similar complication rates, and no randomized trial has shown that the robot improves pain, recovery or complications.

Most robotic adrenalectomies go through the abdomen. Since the adrenal gland is in the back, behind all the other abdominal organs, the instruments and the scope (camera) must work past those organs, and the bowel, spleen, liver or pancreas have to be moved aside, with some potential for injury. Moreover, intra-abdominal adhesions (scars) may have formed from previous operations such as bariatric surgery (gastric band, sleeve gastrectomy, gastric bypass), gallbladder surgery (cholecystectomy), liver surgery, stomach surgery, bowel surgery of any kind (colectomy, appendectomy, etc.) or gynecological operations (C-section, hysterectomy, etc.). An operation through the abdomen has to deal with these adhesions, and it can create new ones, which occasionally cause a bowel obstruction later. The same is true of standard laparoscopic adrenalectomy through the abdomen. Published comparisons of the transabdominal and back approaches favor the back approach for operating time, pain and length of hospital stay, with similar complication rates.

For these reasons, we do not perform or recommend robot-assisted adrenal surgery. To be clear, this is our opinion: we believe the robot adds time and cost to adrenal surgery without proven benefit. If your surgeon suggests using a robot to remove your adrenal gland, ask how many adrenal operations he or she performs each year and why the robot is preferred.

It is possible that robotic surgical systems will become smaller, less expensive and less cumbersome to use in the future, and we follow their development carefully. For now, we do not use the robot for adrenal surgery.

Why Does My Surgeon Want to Perform Robotic Adrenal Surgery on Me?

Surgeons who use the robot for other operations, such as prostate and kidney surgery, often prefer it for the adrenal as well. The robot is an excellent tool for prostate surgery and some other operations. But because the adrenal gland is located in the patient's back, we believe an operation that goes through the back, and not through the front of the abdomen, is a better choice for most patients. What matters most is the surgeon's experience with adrenal surgery, so ask about it.

The back approach has limits of its own: the patient lies face down (prone), which does not suit everyone; the distance from the skin to the adrenal gland matters more than body mass index (BMI); and very large tumors or known adrenal cancers may need a different approach, such as open adrenalectomy, which remains the standard operation for adrenal cancer.

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If Not the Robot, What Operation Should Most People Have?

We believe the Mini Back Scope Adrenalectomy (MBSA) is the best surgical approach for most patients with adrenal tumors, and we use it for more than 95% of our operations. Worldwide, laparoscopic transabdominal adrenalectomy remains the most commonly performed adrenal operation. Whichever operation you have, outcomes are better with a surgeon who performs adrenal surgery regularly.

Last updated October 2026.

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