title: [Minimally invasive technique as the gold standard of adrenal surgery].
abstract: BACKGROUND
  Minimal invasive surgery of the adrenal gland is a "gold standard" procedure worldwide. Authors compare operative data to a historical control group retrospectively analyzing an almost 15 years period.
  
  
  METHODS
  Between 1997 and 2011, 175 transabdominal laparoscopic adrenalectomies were performed with the lateral approach. On the left side, a new "suprasplenic" approach was introduced with the superior mobilization of the spleen, and transection of the short gastric vessels. For larger lesions (above 7 cm) hand assisted laparoscopic method was applied.
  
  
  RESULTS
  Average operative time of laparoscopic surgery was 77 minutes, compared to 115 minutes of open surgery. The average size of the tumor was 3.1 cm in the laparoscopic, and 4.9 cm in the open group. The largest tumors were similar in both groups, however the rate of smaller sized lesions was higher in the laparoscopic one. Conversion was required in 15 cases (8.6%) mostly due to bleeding. Complication rate was 10.8% in the laparoscopic and 24.6% in the conventional group. Hospital stay was significantly shorter with the laparoscopic technique (4.5 vs. 8.1 days). Among laparoscopic cases unexpected primary malignancy was reported in 3 cases (1.7%).
  
  
  CONCLUSIONS
  The laparoscopic technique is the procedure of choice in case of benign adrenal tumors, which offer many advantages. Most metastasis localized to the adrenals can also be removed laparoscopically with expertise and self-restraint, without oncologic compromise. To assure the quality of pre- and postoperative care, cooperation with an endocrinologist is indispensable.
authors.affiliation: Pécsi Tudományegyetem Klinikai Központ, Sebészeti Klinika 7623 Pécs Rákóczi út 2. vereczkei.andras@pte.hu
authors.forename: András
authors.initials: A
authors.lastname: Vereczkei
authors.forename: Adám
authors.initials: A
authors.lastname: Molnár
authors.forename: Ors Péter
authors.initials: OP
authors.lastname: Horváth
mesh_terms: D000293:Adolescent; D000310:Adrenal Gland Neoplasms / Q000473:pathology / Q000601:surgery*; D000315:Adrenalectomy / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods* / Q000592:standards; D000328:Adult; D000368:Aged; D061887:Conversion to Open Surgery; D005260:Female; D006801:Humans; D006814:Hungary / Q000453:epidemiology; D015994:Incidence; D033183:Interdisciplinary Communication; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology; D012189:Retrospective Studies; D016896:Treatment Outcome