title: Factors influencing the rising rates of adrenal surgery: analysis of a 25-year experience.
abstract: BACKGROUND
  Adrenal surgery has been radically changed by laparoscopy and it is reasonable to wonder whether the increase in the number of adrenalectomies is entirely justified. There is still debate on the transperitoneal versus the retroperitoneal approach, the advantages and drawbacks of which are discussed here.
  
  
  METHODS
  Between 1983 and 2007, we performed 279 adrenalectomies in 264 consecutive patients, divided into two groups: before and after the advent of laparoscopic adrenalectomy (LA). We analyzed the factors that increased the number of adrenalectomies in recent years. The LAs were further divided into three consecutive periods and the morbidity and conversion rates, and mean operating times were compared.
  
  
  RESULTS
  More procedures were performed after the advent of LA, i.e., 55 (19.7%) beforehand versus 224 (80.3%) afterwards, irrespective of the type of disease, for instance: incidentaloma, 17.6% versus 82.4% (p \ 0.0001); pheochromocytoma, 20.7% versus 79.3% (p\0.0001); Conn's disease, 19.8% versus 80.2% (p \ 0.0001); Cushing's disease, 17.2% versus 82.8% (p\0.0001); cortical carcinoma, 30% versus 70% (p\0.001). Analyzing the three LA periods, operating times were the only statistically significant variable (p\0.0001).
  
  
  CONCLUSIONS
  The progressive increase in the number of adrenalectomies performed is due more to a better understanding of adrenal disease than to the availability of minimally invasive techniques. The choice of a laparoscopic approach (trans- or retroperitoneal) should depend on the surgeon's experience.
authors.affiliation: Surgical Pathology Medical and Surgical Sciences, University of Padua, Padua, Italy, giorgiolina@libero.it.
authors.forename: Antonio
authors.initials: A
authors.lastname: Toniato
authors.forename: Isabella
authors.initials: I
authors.lastname: Boschin
authors.forename: Paolo
authors.initials: P
authors.lastname: Bernante
authors.forename: Mirto
authors.initials: M
authors.lastname: Foletto
authors.forename: Anna Maria
authors.initials: AM
authors.lastname: Guolo
authors.forename: Maria Rosa
authors.initials: MR
authors.lastname: Pelizzo
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Opocher
authors.forename: Enzo
authors.initials: E
authors.lastname: Ballotta
authors.forename: Franco
authors.initials: F
authors.lastname: Mantero
mesh_terms: D000293:Adolescent; D000307:Adrenal Gland Diseases / Q000601:surgery*; D000315:Adrenalectomy / Q000706:statistics & numerical data*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D002648:Child; D005260:Female; D006801:Humans; D007558:Italy; D010535:Laparoscopy / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D018709:Statistics, Nonparametric