Single-Port Robotic Lateral Transperitoneal Adrenalectomy via an Umbilical Incision: Technical Feasibility and Comparison with Multi-port Laparoscopic Adrenalectomy
This study demonstrates that single-port robotic lateral transperitoneal adrenalectomy via an umbilical incision is a technically feasible and safe alternative to multi-port laparoscopic adrenalectomy, offering comparable safety profiles and shorter hospital stays despite requiring longer operative times.
Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). This is an AI-generated explanation of the paper below. It is not written or endorsed by the authors. For technical accuracy, refer to the original paper. Read full disclaimer
For decades, surgeons have sought to shrink the physical footprint of operations, trading large, open incisions for tiny keyholes that leave the body less scarred and the patient recovering faster. The adrenal glands, small but vital organs perched atop the kidneys that regulate stress and blood pressure, are often the target of such procedures when they develop benign tumors. The standard way to remove these growths has long been laparoscopic surgery, where a surgeon inserts several thin tools through small cuts in the side of the abdomen to grasp and cut the gland free. While effective, this method has physical limits; the rigid tools cannot bend like a human wrist, and the camera can be shaky, making delicate work difficult, especially in patients with more body fat or previous surgeries. To overcome these hurdles, robotic systems were introduced, offering a three-dimensional view and instruments that mimic the dexterity of a human hand. More recently, technology has advanced to allow all these tools to enter through a single opening, promising even less trauma and a nearly invisible scar.
A team of surgeons at Korea University Guro Hospital recently put this newest technology to the test in a specific and challenging way. They developed a technique to remove adrenal glands using a single robotic port placed directly through the navel, approaching the organ from the side through the abdominal cavity. This method, which they call a single-port robotic lateral transperitoneal adrenalectomy, aims to combine the precision of a robot with the cosmetic benefit of hiding the scar inside the belly button. The researchers wanted to know if this approach was safe and practical compared to the traditional multi-port laparoscopic method. To find out, they looked back at their records of thirty patients who had undergone minimally invasive adrenal surgery between 2021 and 2025. After carefully matching patients based on tumor size, body weight, and which side of the body was operated on to ensure a fair comparison, they analyzed eight patients who received the new single-port robotic procedure against eight who received the standard multi-port laparoscopic surgery.
The results showed that the new robotic technique is indeed feasible and safe, though it comes with a trade-off in speed. The surgeons found that the single-port robotic procedure took significantly longer to complete, averaging about 181 minutes, compared to roughly 94 minutes for the traditional laparoscopic approach. This difference reflects the learning curve and the technical complexity of maneuvering multiple flexible tools through a single small hole. However, the extra time did not lead to more complications. In both groups, no patients needed to be converted to open surgery, and no one suffered surgical complications or had to return to the hospital within thirty days. The most notable benefit of the new method appeared in the recovery room: patients who underwent the single-port robotic surgery were discharged from the hospital sooner, staying an average of 2.38 days compared to 3 days for the traditional group.
The study also highlighted the specific challenges and adaptations required for this new approach. Because the robotic system used in this study lacks some of the advanced energy tools found in larger systems, the surgeons had to be exceptionally careful with bleeding control. They used a modified drainage tube inserted directly through the surgical port to help manage any bleeding and keep the view clear. The instruments used were also slightly smaller than those in standard robotic systems, which meant the surgeons had to be gentle when pulling on fatty tissue around the gland. Despite these constraints, the team successfully removed tumors ranging from 1.6 to 5.5 centimeters without incident. The patients in the robotic group were, on average, older than those in the traditional group, yet the safety profile remained excellent for both.
Ultimately, the research suggests that removing adrenal glands through a single incision in the navel using a robotic system is a viable option for carefully selected patients with benign tumors. While the procedure takes nearly twice as long as the standard method, it offers a safe alternative that may allow for a quicker return home and leaves a scar that is virtually hidden. The authors note that as surgeons gain more experience with this specific technique, the time required to perform the operation may decrease. For now, the study confirms that this advanced approach works, providing a new tool in the surgeon's arsenal that prioritizes both precision and the cosmetic outcome for the patient.
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