title: Retroperitoneal endoscopic adrenalectomy is safe and effective.
abstract: BACKGROUND
  The aim of this study was to review an experience with retroperitoneal endoscopic adrenalectomy (REA). This is the procedure of choice for adrenal tumours at this institution.
  
  
  METHODS
  Between 1997 and 2008, 112 REAs were performed in a single university centre. Data were retrieved retrospectively from a prospectively collected database, including information on patient demographics, surgical procedure, complications and hospital stay.
  
  
  RESULTS
  One hundred and twelve REAs were carried out successfully in 105 patients, including seven bilateral adrenalectomies. Thirty-nine patients with unilateral adrenal disease had a phaeochromocytoma, of whom 16 had multiple endocrine neoplasia syndrome type 2, 21 patients had Cushing's disease and 20 had Conn's disease. Median body mass index was 27 (interquartile range 23-29) kg/m(2). The median duration of unilateral operations was 100 (90-130) min with a median blood loss of 5 ml. Median tumour size was 3.1 (2.0-4.4) cm. Conversion from REA to open surgery was needed in two patients. Seven patients experienced postoperative complications (2 major, 5 minor). One patient needed a reoperation. The median postoperative hospital stay was 3 days. A learning curve with a significant decrease in operating time was observed over the years.
  
  
  CONCLUSIONS
  REA appears to be a safe and effective surgical technique for adrenal gland tumours up to 6 cm in diameter, with a minimal complication rate.
authors.affiliation: Department of Surgery, University Medical Centre Utrecht, Utrecht, The Netherlands.
authors.forename: J M J
authors.initials: JM
authors.lastname: Schreinemakers
authors.forename: G J
authors.initials: GJ
authors.lastname: Kiela
authors.forename: G D
authors.initials: GD
authors.lastname: Valk
authors.forename: M R
authors.initials: MR
authors.lastname: Vriens
authors.forename: I H M Borel
authors.initials: IH
authors.lastname: Rinkes
mesh_terms: D000293:Adolescent; D000310:Adrenal Gland Neoplasms / Q000601:surgery*; D000315:Adrenalectomy / Q000009:adverse effects / Q000379:methods*; D018246:Adrenocortical Adenoma / Q000601:surgery; D000328:Adult; D000368:Aged; D002648:Child; D004724:Endoscopy / Q000379:methods*; D004812:Epidemiologic Methods; D006801:Humans; D008875:Middle Aged; D010673:Pheochromocytoma / Q000601:surgery; D047748:Pituitary ACTH Hypersecretion / Q000601:surgery; D011183:Postoperative Complications / Q000517:prevention & control*; D000091402:Prohibitins; D012187:Retroperitoneal Space; D016896:Treatment Outcome; D055815:Young Adult