Day-case robotic adrenalectomy under ERAS protocol: early outcomes from a single-centre experience

PURPOSE: To evaluate the feasibility and outcomes of a day-case robotic adrenalectomy programme implemented within a structured Enhanced Recovery After Surgery (ERAS) framework. MATERIALS AND METHODS: system and managed under an ERAS protocol incorporating multimodal analgesia, early mobilisation, and omission of postoperative drains and catheters. A transversus abdominis plane (TAP) block was administered intraoperatively for analgesia. Outcomes included operative metrics, perioperative complications, 30-day readmissions, and patient-reported satisfaction measured by the Evaluation du Vécu de l'Anesthésie Générale (EVAN-G) questionnaire. RESULTS: Thirteen patients were included. The median age was 49.0 years (46.0-60.0), and the median BMI was 30.0 kg/m² (28.0-36.5). Most patients were male (61.5%, n = 8), all were ASA grade 2, and 69.2% (n = 9) had an ECOG performance status of 0. The median estimated blood loss was 10.0 mL (5.0-10.0) and the median operative time was 56.0 min (30.5-75.0 min). A history of prior abdominal surgery was present in 38.5% of patients (n = 5). Indications included primary hyperaldosteronism (69.2%, n = 9), androgen-producing tumour (n = 1), RCC metastasis (n = 1), and adrenocortical carcinoma (n = 2). No intraoperative or postoperative complications occurred, no patients required readmission, and the median EVAN-G score was 94 (91-96). On preoperative imaging, the median tumour size was 16.0 mm (13.0-26.5 mm). Postoperative pathological analysis reported a median adrenal gland size of 63.0 mm (50.0-72.5 mm) and a median lesion size of 15.0 mm (9.0-22.5 mm). CONCLUSION: Day-case robotic adrenalectomy performed under an ERAS protocol is safe and well-tolerated in selected patients.