title: Posterior retroperitoneoscopic adrenalectomy: a contemporary American experience.
abstract: BACKGROUND
  Posterior retroperitoneoscopic adrenalectomy (PRA) is an excellent surgical option for adrenal gland removal. The operation requires that surgeons learn a new approach with few similarities to anterior adrenalectomy. This study reports a large series of PRAs incorporated into surgical care using a team-model approach.
  
  
  METHODS
  The prospective endocrine surgery database was queried to identify patients who underwent PRA during a recent 4-year period. Demographic, operative, and pathologic data were recorded. The authors' initial experiences with PRA (group 1) are compared with our contemporary experience (group 2).
  
  
  RESULTS
  One hundred and eighteen PRAs were successfully performed (100 unilateral and 9 bilateral). Indications were pheochromocytoma in 21 patients, Cushing's syndrome or Cushing's disease in 22 patients, aldosteronoma in 22 patients, virilizing tumor in 3 patients, isolated metastasis in 28 patients, and nonfunctional mass in 19 patients. Forty-eight percent of patients had undergone earlier abdominal surgery. Forty-eight percent were obese (body mass index [calculated as kg/m(2)] ≥30). No significant differences were found in operative time (110 versus 118 minutes, p = 0.30), tumor size (2.59 versus 2.85 cm, p = 0.44), or body mass index (29.63 versus 29.93, p = 0.82) between groups 1 and 2. Both complications (15.9% versus 7.7%, p = 0.29) and conversion rates (9.5% versus 1.9%, p = 0.19) were lower in group 2, although this was not statistically significant.
  
  
  CONCLUSIONS
  PRA is a technique safely performed for a variety of adrenal lesions, is ideal for patients who have undergone earlier abdominal surgery, and is feasible in obese patients. Proficiency can be obtained during a short period, leading to low conversion and complication rates. This technique should be incorporated into the armamentarium of the endocrine surgeon. A team approach to learning new surgical techniques is effective.
authors.affiliation: Department of Surgical Oncology, MD Anderson Cancer Center, Houston, TX 77030, USA.
authors.forename: Paxton V
authors.initials: PV
authors.lastname: Dickson
authors.forename: Camilo
authors.initials: C
authors.lastname: Jimenez
authors.forename: Gary B
authors.initials: GB
authors.lastname: Chisholm
authors.forename: Debra L
authors.initials: DL
authors.lastname: Kennamer
authors.forename: Chaan
authors.initials: C
authors.lastname: Ng
authors.forename: Elizabeth G
authors.initials: EG
authors.lastname: Grubbs
authors.forename: Douglas B
authors.initials: DB
authors.lastname: Evans
authors.forename: Jeffrey E
authors.initials: JE
authors.lastname: Lee
authors.forename: Nancy D
authors.initials: ND
authors.lastname: Perrier
mesh_terms: D000307:Adrenal Gland Diseases / Q000150:complications / Q000473:pathology / Q000601:surgery*; D000315:Adrenalectomy; D015331:Cohort Studies; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications / Q000473:pathology / Q000601:surgery; D012187:Retroperitoneal Space; D012189:Retrospective Studies; D016896:Treatment Outcome