[Development and evolution of laparoscopic adrenalectomy in an specialized team: from the beginning to the outpatient setting].
BACKGROUND
After the first reports in 1992, laparoscopic adrenalectomy (LA) has evolved technically until becoming the standard approach for the treatment of most of the adrenal gland diseases.


METHODS
Retrospective and descriptive study of 67 patients who underwent 68 LA between January-1998 and December-2008 in the Laparoscopic Surgery Unit of the General and Digestive Surgery Service in a third level hospital (only one case of bilateral LA). The group was divided in 2 periods, P-1 (1998-2003, 22 cases) and P-2 (2004-2008, 45 cases), which have been compared to evaluate the evolution of the LA technique.


RESULTS
Indications for LA were: 19 incidentalomas, 19 primary hyperaldosteronism, 18 pheocromocitoms, 5 cases of symptomatic and non-functioning adrenal masses, 4 Cushing adenomas and 2 metastases. There was no mortality, only 4 patients had minor complications (6%) and conversion rate was only 3% (2 cases). Mean size of adrenal glands resected was 3.83 cm and the mean operative time was 86 minutes. Mean postoperative hospital stay was 3 days and in P-2 seventeen patients were discharged on an outpatient basis (hospital stay less than 23 hours).


CONCLUSIONS
In our experience, LA for the treatment of adrenal diseases has shown to be safe, effective and reproducible with low complications and excellent tolerance by patients. When the learning curve is overcome, hospital stay and operative time clearly decrease. As a consequence, LA can be planned in selected cases as outpatient surgery with good results.
Ramírez-Plaza
César P
CP
Servicio de Cirugía General, Digestiva y Trasplantes, Hospital Regional Universitario de Málaga Carlos Haya, Málaga, España. cprptot@hotmail.com
Rodríguez-Cañete
Alberto
A
Domínguez-López
Marta E
ME
Valle-Carbajo
Marta
M
Jiménez-Mazure
Carolina
C
Marín-Camero
Naiara
N
Gallego-Perales
José L
JL
Santoyo-Santoyo
Julio
J
D000293:Adolescent; D000307:Adrenal Gland Diseases / Q000601:surgery*; D000315:Adrenalectomy / Q000379:methods* / Q000639:trends; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D055815:Young Adult