title: Factors influencing outcomes in laparoscopic adrenal surgery.
abstract: OBJECTIVE
  This study aims to recognize factors affecting operative and postoperative outcomes in patients undergoing unilateral laparoscopic adrenalectomy performed by using the transabdominal approach.
  
  
  METHODS
  From a prospectively collected adrenal database, we performed a retrospective analysis of all patients undergoing unilateral adrenalectomy from July 2002 to December 2011. The outcome measures considered were the following: conversion rate, intra- and postoperative complications, duration of surgery, length of hospital stay, and return-to-work time. Demographic data, American Society of Anesthesiologists score, characteristics of adrenal tumor, and operative and postoperative variables were analyzed to assess their influence on the outcome variables.
  
  
  RESULTS
  A total of 163 laparoscopic adrenalectomies were included. Intraoperative complications, conversion to laparotomy, and postoperative complications were observed in 6.7, 6.1, and 1.8 % of cases, respectively. Conversion to open surgery, intraoperative complications, metastasis, and pheochromocytoma were found to be predictive factors for operative time of >140 min. An operative duration of >140 min was associated with intraoperative complications. Tumor size, intraoperative complications, and adrenalectomy for metastasis significantly increased conversion rate. Hospital stay was extended by operative time of >140 min, conversion to laparotomy, and postoperative complications.
  
  
  CONCLUSIONS
  Our study highlights that simple clinical variables, long procedures, and operative complications have a negative impact on procedural outcomes. Based on this, it may be possible to predict cases requiring collaboration with experienced surgeons in order to minimize perioperative morbidity.
authors.affiliation: Surgical Clinic, Department of Experimental and Clinical Sciences, University of Brescia, Brescia, Italy. gtiberio@med.unibs.it
authors.forename: Guido Alberto Massimo
authors.initials: GA
authors.lastname: Tiberio
authors.forename: Leonardo
authors.initials: L
authors.lastname: Solaini
authors.forename: Luca
authors.initials: L
authors.lastname: Arru
authors.forename: Giulia
authors.initials: G
authors.lastname: Merigo
authors.forename: Gian Luca
authors.initials: GL
authors.lastname: Baiocchi
authors.forename: Stefano Maria
authors.initials: SM
authors.lastname: Giulini
mesh_terms: D000307:Adrenal Gland Diseases / Q000601:surgery*; D000315:Adrenalectomy; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000453:epidemiology; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D062707:Return to Work; D016896:Treatment Outcome