Advances in robotic adrenalectomy.

We review the development of robotic adrenalectomy over the last decade, focusing on specific technical advances in the last 18 months. The learning curve for robotic adrenalectomy, after which conversion rates and operative times significantly decrease, is more than 20 cases even in surgeons with extensive laparoscopic experience. Two new uses of the robot to extend traditional laparoscopic adrenalectomy have been highlighted in recent studies. Posterior retroperitoneoscopic adrenalectomy can be aided by robotic assistance, particularly in patients whose adrenal gland is located well superior to the 12th rib, on the anterior surface of the kidney, or in the renal hilum. Robotic assistance has also enabled cortical-sparing adrenalectomy which may obviate the need for steroid hormone replacement in patients with multiple or bilateral tumors. Robot-assisted adrenalectomy can extend the capabilities of traditional laparoscopy, particularly in regard to performing posterior retroperitoneal and subtotal adrenalectomies.