Adrenalectomy as a Treatment Option for Primary Aldosteronism in the Era of Robotic-Assisted Surgeries—Is It Time to Use It More Often?

Raz, Orit; Nakash Niddam, Naomi; Atamna, Fahed; Simonovsky, Alla; Litvin, Sergey; Leonov Polak, Mia; Leiba, Adi; Golomb, Dor

doi:10.3390/jcm15010173

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Adrenalectomy as a Treatment Option for Primary Aldosteronism in the Era of Robotic-Assisted Surgeries—Is It Time to Use It More Often?

by

Orit Raz

¹,

Naomi Nakash Niddam

²,

Fahed Atamna

¹,

Alla Simonovsky

³,

Sergey Litvin

⁴,

Mia Leonov Polak

⁵,

Adi Leiba

² and

Dor Golomb

^1,*

¹

Department of Urology, Samson Assuta Ashdod University Hospital, 7 Harefua St., Ashdod 7747629, Israel

²

Department of Nephrology, Samson Assuta Ashdod University Hospital, Ashdod 7747629, Israel

³

Department of Diagnostic Radiology, Samson Assuta Ashdod University Hospital, Ashdod 7747629, Israel

⁴

Department of Interventional Radiology, Samson Assuta Ashdod University Hospital, Ashdod 7747629, Israel

⁵

Department of Pathology, Samson Assuta Ashdod University Hospital, Ashdod 7747629, Israel

^*

Author to whom correspondence should be addressed.

J. Clin. Med. 2026, 15(1), 173; https://doi.org/10.3390/jcm15010173

Submission received: 26 November 2025 / Revised: 14 December 2025 / Accepted: 24 December 2025 / Published: 25 December 2025

(This article belongs to the Special Issue Clinical Advances in Minimally Invasive Urologic Surgery)

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Abstract

Objectives: To evaluate clinical and biochemical outcomes of robotic-assisted laparoscopic adrenalectomy in patients with primary aldosteronism (PA) due to small aldosterone-producing adenomas, with emphasis on blood pressure (BP) control, antihypertensive medication burden, hormonal normalization, and safety. Methods: We prospectively enrolled PA patients (aldosterone >10 ng/dL, renin <2 μU/mL) undergoing robotic adrenalectomy by a single surgeon. Exclusions included suspected pheochromocytoma, other adrenal pathologies, or malignancy. Outcomes were classified per PASO criteria at 6 months: complete success (BP <140/90 mmHg without medications + normalized aldosterone (<10 ng/dL) and renin (>2 μU/mL)), partial success (improvement in BP control with reduced medication and/or partial biochemical improvement), and failure (persistent hypertension and abnormal hormone levels). Results: From 2019 to present, 18 patients (median age 53 years; 13 male) with a median adenoma size of 15 mm (IQR 10–19.8) underwent robotic adrenalectomy (12 left, 6 right). Three (16.7%) with bilateral imaging findings had adrenal vein sampling to confirm unilateral disease. At 6 months, complete clinical success was achieved in 10 (55.5%) patients, partial success in 7 (38.9%), and failure in 1 (5.6%). Biochemically, 12 achieved complete normalization, 3 achieved partial improvement, and 3 did not complete testing. Median operative time was 110 min (IQR 100–120); median hospital stay was 3 days (IQR 3–4). No intra- or postoperative complications, transfusions, infections, or readmissions occurred. Conclusions: Robotic adrenalectomy for small aldosterone-producing adenomas in PA is safe, with high rates of BP normalization and hormonal remission and significantly reduced antihypertensive medication burden.

Keywords: adrenal; primary aldosteronism; robotic adrenalectomy

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MDPI and ACS Style

Raz, O.; Nakash Niddam, N.; Atamna, F.; Simonovsky, A.; Litvin, S.; Leonov Polak, M.; Leiba, A.; Golomb, D. Adrenalectomy as a Treatment Option for Primary Aldosteronism in the Era of Robotic-Assisted Surgeries—Is It Time to Use It More Often? J. Clin. Med. 2026, 15, 173. https://doi.org/10.3390/jcm15010173

AMA Style

Raz O, Nakash Niddam N, Atamna F, Simonovsky A, Litvin S, Leonov Polak M, Leiba A, Golomb D. Adrenalectomy as a Treatment Option for Primary Aldosteronism in the Era of Robotic-Assisted Surgeries—Is It Time to Use It More Often? Journal of Clinical Medicine. 2026; 15(1):173. https://doi.org/10.3390/jcm15010173

Chicago/Turabian Style

Raz, Orit, Naomi Nakash Niddam, Fahed Atamna, Alla Simonovsky, Sergey Litvin, Mia Leonov Polak, Adi Leiba, and Dor Golomb. 2026. "Adrenalectomy as a Treatment Option for Primary Aldosteronism in the Era of Robotic-Assisted Surgeries—Is It Time to Use It More Often?" Journal of Clinical Medicine 15, no. 1: 173. https://doi.org/10.3390/jcm15010173

APA Style

Raz, O., Nakash Niddam, N., Atamna, F., Simonovsky, A., Litvin, S., Leonov Polak, M., Leiba, A., & Golomb, D. (2026). Adrenalectomy as a Treatment Option for Primary Aldosteronism in the Era of Robotic-Assisted Surgeries—Is It Time to Use It More Often? Journal of Clinical Medicine, 15(1), 173. https://doi.org/10.3390/jcm15010173

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Adrenalectomy as a Treatment Option for Primary Aldosteronism in the Era of Robotic-Assisted Surgeries—Is It Time to Use It More Often?

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