Robotic versus laparoscopic adrenalectomy: five-year comparative outcomes from a high-volume tertiary endocrine surgery center.

Laparoscopic adrenalectomy (LA) is the standard minimally invasive approach, whereas robotic adrenalectomy (RA) is increasingly adopted for its ergonomic and technical advantages. Whether these benefits improve perioperative outcomes-particularly by adrenal laterality-remains unclear. This study compared RA and LA outcomes via structured side-specific analysis. A total of 198 patients were screened in this retrospective cohort study, which included adults who underwent minimally invasive adrenalectomy between June 2020 and September 2025. Patients with paragangliomas, recurrent disease, or open adrenalectomy were excluded. Clinical, operative, and postoperative variables were collected, and laterality-specific subgroup analyses and multivariable linear regression were performed. A total of 181 patients were analyzed (126 LA, 55 RA). The length of hospital stay was significantly shorter in the RA group (p = 0.019), whereas the operative time was significantly longer in the RA group than the LA group (p < 0.001). No significant differences were observed between techniques regarding complications, transfusions, or conversion rates (all p > 0.05). When stratified by laterality, the RA consistently demonstrated longer operative times for both right- and left-sided procedures (p = 0.001 and p < 0.001, respectively). In the multivariate analysis, only the surgical approach and tumor diameter independently affected the operative time (both p < 0.001). Robotic adrenalectomy demonstrated perioperative safety comparable to that of laparoscopy while providing the advantage of a shorter hospital stay despite longer operative times. Given its similar complication and conversion profiles, RA represents a feasible and ergonomically favorable procedure in endocrine surgery centers.