title: Laparoscopic expertise increases hospital volume of adrenal surgery.
abstract: The laparoscopic approach is preferred for most adrenal tumors but technical challenges limit its use. We evaluated the effects of the availability of laparoscopic expertise on the volume of the adrenal surgery at a tertiary care hospital. Patients undergoing adrenalectomy 5 years before and 5 years after an advanced laparoscopic program was established were retrospectively reviewed. The average annual volume increased from 2 cases during the first period to 15 cases during the 5 years (1999-2003) after laparoscopic expertise became available. The average distance of travel to the hospital was significantly greater for the latter patients and significantly more patients were referred from outside of a 30-mile radius. Although the average statewide annual number of adrenalectomies has not significantly changed, the proportion of adrenalectomies performed at our institution rose. Offering a laparoscopic approach has altered physicians' referral patterns and has significantly increased the volume of adrenal surgery at the institution.
authors.affiliation: Department of Surgery, Division of GI and Minimally Invasive Surgery, Carolinas Medical Center, Charlotte, North Carolina 28203, USA.
authors.forename: Yuri W
authors.initials: YW
authors.lastname: Novitsky
authors.forename: Kent W
authors.initials: KW
authors.lastname: Kercher
authors.forename: Andrew G
authors.initials: AG
authors.lastname: Harrell
authors.forename: B Todd
authors.initials: BT
authors.lastname: Heniford
mesh_terms: D000307:Adrenal Gland Diseases / Q000601:surgery*; D000315:Adrenalectomy / Q000706:statistics & numerical data*; D000328:Adult; D002983:Clinical Competence; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D010535:Laparoscopy / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D009657:North Carolina; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012189:Retrospective Studies