title: Laparoscopic adrenalectomy: lessons learned from 306 cases.
abstract: BACKGROUND
  Laparoscopic adrenalectomy has become the standard of care for the surgical treatment of benign adrenal pathology. We present the following case series documenting our experience in refinement of this approach.
  
  
  METHODS
  Analysis of patient records identified those in whom laparoscopic adrenalectomy was performed from January 1997 through February 2010. Study variables included indications, operative time, blood loss, length of hospital stay, histopathological evaluation, and complications.
  
  
  RESULTS
  Laparoscopic adrenalectomy was performed in 306 patients using the transperitoneal lateral approach. No major operative complications were noted, and postoperative complications included a pulmonary embolism and 2 cases of pneumonia. Conversion to the open approach was necessitated in two cases. The median operative time was 95±29 minutes (range, 45-145 minutes). Estimated blood loss was 60 mL (range, 30-150 mL). The mean size of the removed gland was 5.9±1.6 cm (range, 3-13 cm). The mean size of the tumor was 5±2 cm (range, 0.5-12 cm). The median hospitalization was 4±3.7 days (range, 2-22 days). Adrenal pathology included adenoma (n=164), pheochromocytoma (n=79), hyperplasia (n=35), metastatic carcinoma (n=22), cyst (n=9), myelolipoma (n=9), hemangioma (n=3), ganglioneuroma (n=3), and melanoma (n=2).
  
  
  CONCLUSIONS
  Laparoscopic adrenalectomy is a safe and feasible approach to adrenal pathology, providing the patients with all the benefits of minimally invasive surgery.
authors.affiliation: Department of Urology, University of Zagreb, Zagreb, Croatia. tkulis@gmail.com
authors.forename: Tomislav
authors.initials: T
authors.lastname: Kulis
authors.forename: Nikola
authors.initials: N
authors.lastname: Knezevic
authors.forename: Marijeta
authors.initials: M
authors.lastname: Pekez
authors.forename: Darko
authors.initials: D
authors.lastname: Kastelan
authors.forename: Marija
authors.initials: M
authors.lastname: Grkovic
authors.forename: Zeljko
authors.initials: Z
authors.lastname: Kastelan
mesh_terms: D000236:Adenoma / Q000601:surgery; D000293:Adolescent; D000307:Adrenal Gland Diseases / Q000473:pathology / Q000601:surgery*; D000310:Adrenal Gland Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery; D000311:Adrenal Glands / Q000473:pathology; D000315:Adrenalectomy / Q000379:methods* / Q000706:statistics & numerical data; D000328:Adult; D000368:Aged; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data; D003480:Cushing Syndrome / Q000601:surgery; D005260:Female; D006801:Humans; D006965:Hyperplasia; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010673:Pheochromocytoma / Q000601:surgery; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D055815:Young Adult