title: From open to laparoscopic adrenalectomy: thirty years' experience of one medical centre.
abstract: BACKGROUND
  Laparoscopic adrenalectomy (LA) has become the standardized treatment of benign adrenal lesions over the last two decades, making the indications to open adrenalectomy (OA) limited. The purpose of this study was to show the thirty years of experience in open (OA) and laparoscopic adrenalectomy (LA) gained in one medical centre as well as to compare the results of OA and LA performed for benign adrenal lesions.
  
  
  METHODS
  Three hundred patients underwent 127 open and 173 laparoscopic adrenalectomies between 1979 and 2009 at M. Curie Hospital in Szczecin, Poland. Analyzed factors included patients demographic data, ASA score, indication for surgery, tumour size and side, characteristics of the removed tumours, intraoperative and postoperative outcome of LA and OA, postoperative pain sensation, intraoperative and postoperative complications, and conversion rate from LA to OA. Tumours with diameter exceeding 8 cm were excluded.
  
  
  RESULTS
  There were no significant differences regarding the analyzed preoperative data in both groups of patients. The mean operative time was longer in the LA group (137 v. 82 min., p < 0.0001) and the blood loss was lower in LA group (110 v. 254 mL, p < 0.0001). The mean time until resumption of normal diet was shorter after LA (22 v. 44 h), as was the mean time until ambulation (17 v. 36 h), mean length of the hospital stay (4.6 v. 6.8 days), and mean time until return to normal activities (14 v. 23 days, p < 0.0001 for each difference). The analgesic requirement on the first and the second day postoperatively was lower in the LA group (p < 0.0001). The incidence of intraoperative and postoperative complications did not differ significantly between both analyzed groups. The rate of the conversion from LA to OA was 16%. The histopathological diagnosis was adenoma of the adrenal gland in the majority of cases.
  
  
  CONCLUSIONS
  This study shows that LA is a safe, effective, and well-tolerated procedure. It may be recommended as a "gold standard" surgery in a case of benign functioning or non-functioning adrenal tumours with diameter less than 8 cm. (Pol J Endocrinol 2010; 61 (1): 94-101).
authors.affiliation: M. Skłodowska-Curie Hospital, Department of General and Transplantation Surgery, Szczecin, Poland. lubikowski@neostrada.pl
authors.forename: Jerzy
authors.initials: J
authors.lastname: Lubikowski
authors.forename: Marek
authors.initials: M
authors.lastname: Umiński
authors.forename: Elzbieta
authors.initials: E
authors.lastname: Andrysiak-Mamos
authors.forename: Sławomir
authors.initials: S
authors.lastname: Pynka
authors.forename: Henryk
authors.initials: H
authors.lastname: Fuchs
authors.forename: Maciej
authors.initials: M
authors.lastname: Wójcicki
authors.forename: Mikołaj
authors.initials: M
authors.lastname: Szajko
authors.forename: Piotr
authors.initials: P
authors.lastname: Moleda
authors.forename: Mariola
authors.initials: M
authors.lastname: Post
authors.forename: Ewa
authors.initials: E
authors.lastname: Zochowska
authors.forename: Bartosz
authors.initials: B
authors.lastname: Kiedrowicz
authors.forename: Krzysztof
authors.initials: K
authors.lastname: Safranow
authors.forename: Anhelli
authors.initials: A
authors.lastname: Syrenicz
mesh_terms: D000293:Adolescent; D000307:Adrenal Gland Diseases / Q000601:surgery*; D000310:Adrenal Gland Neoplasms / Q000601:surgery; D000315:Adrenalectomy / Q000379:methods* / Q000706:statistics & numerical data; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods* / Q000706:statistics & numerical data; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D011044:Poland; D016896:Treatment Outcome; D055815:Young Adult