title: Laparoscopic adrenalectomy in urological centres - the experience of the German Laparoscopic Working Group.
abstract: OBJECTIVE
  To evaluate the safety and feasibility of laparoscopic adrenalectomy (LA) performed in several German centres with different laparoscopic experience, as LA has become the gold-standard approach for benign surgical adrenal disorders; however, for solitary metastasis or primary adrenal cancer its precise role is uncertain.
  
  
  METHODS
  The data of 363 patients who underwent a LA were prospectively collected in 23 centres. All centres were stratified into three groups according to their experience: group A (<10 LAs/year), group B (10-20 LAs/year) and group C (>20 LAs/year). In all, 15 centres used a transperitoneal approach, four a retroperitoneal approach and four both approaches. Demographic data, perioperative and postoperative variables, including operating time, surgical approach, tumour size, estimated blood loss, complications, hospital stay and histological tumour staging, were collected and analysed.
  
  
  RESULTS
  The transperitoneal approach was used in 281 cases (77.4%) and the retroperitoneal approach was used in 82 patients (22.6%). In all, 263 of 363 lesions (72.5%) were benign and 100 (27.5%) were malignant. The mean (sd) operating time was 127.22 (55.56) min and 130.16 (49.88) min after transperitoneal and retroperitoneal LA, respectively. The mean complication rates for transperitoneal and retroperitoneal LA were 5% and 10.9%, respectively.
  
  
  CONCLUSIONS
  LAs performed by urologists experienced in laparoscopy is safe for the removal of benign and malignant adrenal masses. LA for malignant adrenal tumours should be performed only in high-volume centres by a surgeon performing at least >10 LAs/year.
authors.affiliation: Department of Urology and Kidney Transplantation, Martin Luther University, Halle/Saale, Germany. francesco.greco@medizin.uni-halle-de
authors.forename: Francesco
authors.initials: F
authors.lastname: Greco
authors.forename: M Raschid
authors.initials: MR
authors.lastname: Hoda
authors.forename: Jens
authors.initials: J
authors.lastname: Rassweiler
authors.forename: Dirk
authors.initials: D
authors.lastname: Fahlenkamp
authors.forename: Dietmar A
authors.initials: DA
authors.lastname: Neisius
authors.forename: Andreas
authors.initials: A
authors.lastname: Kutta
authors.forename: Joachim W
authors.initials: JW
authors.lastname: Thüroff
authors.forename: Andreas
authors.initials: A
authors.lastname: Krause
authors.forename: Walter L
authors.initials: WL
authors.lastname: Strohmaier
authors.forename: Alexander
authors.initials: A
authors.lastname: Bachmann
authors.forename: Lothar
authors.initials: L
authors.lastname: Hertle
authors.forename: Gralf
authors.initials: G
authors.lastname: Popken
authors.forename: Serdar
authors.initials: S
authors.lastname: Deger
authors.forename: Christian
authors.initials: C
authors.lastname: Doehn
authors.forename: Dieter
authors.initials: D
authors.lastname: Jocham
authors.forename: Tillmann
authors.initials: T
authors.lastname: Loch
authors.forename: Sven
authors.initials: S
authors.lastname: Lahme
authors.forename: Volker
authors.initials: V
authors.lastname: Janitzky
authors.forename: Christian P
authors.initials: CP
authors.lastname: Gilfrich
authors.forename: Theodor
authors.initials: T
authors.lastname: Klotz
authors.forename: Bernd
authors.initials: B
authors.lastname: Kopper
authors.forename: Udo
authors.initials: U
authors.lastname: Rebmann
authors.forename: Tilman
authors.initials: T
authors.lastname: Kälbe
authors.forename: Ulrich
authors.initials: U
authors.lastname: Wetterauer
authors.forename: Armin
authors.initials: A
authors.lastname: Leitenberger
authors.forename: Jörg
authors.initials: J
authors.lastname: Rassler
authors.forename: Felix
authors.initials: F
authors.lastname: Kawan
authors.forename: Antonino
authors.initials: A
authors.lastname: Inferrera
authors.forename: Sigrid
authors.initials: S
authors.lastname: Wagner
authors.forename: Paolo
authors.initials: P
authors.lastname: Fornara
mesh_terms: D000307:Adrenal Gland Diseases / Q000601:surgery*; D000310:Adrenal Gland Neoplasms / Q000601:surgery; D000315:Adrenalectomy / Q000009:adverse effects / Q000379:methods*; D000368:Aged; D005240:Feasibility Studies; D005260:Female; D005858:Germany; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D016896:Treatment Outcome