title: [Development and evolution of laparoscopic adrenalectomy in an specialized team: from the beginning to the outpatient setting].
abstract: 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.
authors.affiliation: Servicio de Cirugía General, Digestiva y Trasplantes, Hospital Regional Universitario de Málaga Carlos Haya, Málaga, España. cprptot@hotmail.com
authors.forename: César P
authors.initials: CP
authors.lastname: Ramírez-Plaza
authors.forename: Alberto
authors.initials: A
authors.lastname: Rodríguez-Cañete
authors.forename: Marta E
authors.initials: ME
authors.lastname: Domínguez-López
authors.forename: Marta
authors.initials: M
authors.lastname: Valle-Carbajo
authors.forename: Carolina
authors.initials: C
authors.lastname: Jiménez-Mazure
authors.forename: Naiara
authors.initials: N
authors.lastname: Marín-Camero
authors.forename: José L
authors.initials: JL
authors.lastname: Gallego-Perales
authors.forename: Julio
authors.initials: J
authors.lastname: Santoyo-Santoyo
mesh_terms: 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