title: Mini-retroperitoneoscopic adrenalectomy: our experience after 50 procedures.
abstract: OBJECTIVE
  To present our experience with retroperitoneoscopic adrenalectomy using 3-mm instruments (mini-rA) for adrenal tumors.
  
  
  METHODS
  From March 2009 to May 2013, patients with adrenal tumors <6 cm in size and body mass index ≤ 35 were involved in this prospective study and underwent mini-rA performed by 3-mm instruments. Demographic, endocrine and perioperative data, and cosmetic results (using Patient Scar Assessment Questionnaire and Scoring System) were recorded and analyzed.
  
  
  RESULTS
  Fifty procedures were performed in 48 patients. All procedures were performed with neither conversion to open surgery nor reoperation or mortality. Median operative time and blood loss were 90 minutes (range, 45-210 minutes) and 50 mL (range, 20-210 mL), respectively. Only 1 intraoperative complication (2%) was recorded. Conversion to conventional laparoscopy was needed in 4 procedures (8%). Postoperative complications were recorded in 6 cases (Clavien grade ≤ 2). No differences were recorded in terms of perioperative variables when comparing procedures performed in patients having secreting tumors (n = 18) with other ones (n = 32). On the contrary, procedures performed in patients having benign lesions (n = 41) had significantly lower operative times and complications with respect to those performed in patients with malignant lesions (n = 9). Median Patient Scar Assessment Questionnaire score was 30 (minimum score 28 = the best result; maximum score = 112, the worst result).
  
  
  CONCLUSIONS
  In selected population, mini-rA is a feasible, safe, and effective technique in the treatment of adrenal masses <6 cm in size, offering objectively proven excellent patients' satisfaction with symptoms and cosmesis. Significant experience before embarking in this kind of surgery is recommended.
authors.affiliation: Division of Urology, Department of Oncology, University of Turin "San Luigi" Hospital, Orbassano, Turin, Italy. Electronic address: porpiglia@libero.it.
authors.forename: Francesco
authors.initials: F
authors.lastname: Porpiglia
authors.affiliation: Division of Urology, Department of Oncology, University of Turin "San Luigi" Hospital, Orbassano, Turin, Italy.
authors.forename: Cristian
authors.initials: C
authors.lastname: Fiori
authors.affiliation: Division of Urology, Department of Oncology, University of Turin "San Luigi" Hospital, Orbassano, Turin, Italy.
authors.forename: Riccardo
authors.initials: R
authors.lastname: Bertolo
authors.affiliation: Division of Urology, Department of Oncology, University of Turin "San Luigi" Hospital, Orbassano, Turin, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Cattaneo
authors.affiliation: Division of Urology, Department of Oncology, University of Turin "San Luigi" Hospital, Orbassano, Turin, Italy.
authors.forename: Daniele
authors.initials: D
authors.lastname: Amparore
authors.affiliation: Division of Urology, Department of Oncology, University of Turin "San Luigi" Hospital, Orbassano, Turin, Italy.
authors.forename: Ivano
authors.initials: I
authors.lastname: Morra
authors.affiliation: Division of Urology, Department of Oncology, University of Turin "San Luigi" Hospital, Orbassano, Turin, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Didio
authors.affiliation: Division of Urology, Department of Oncology, University of Turin "San Luigi" Hospital, Orbassano, Turin, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: De Luca
authors.affiliation: Division of Urology, Department of Oncology, University of Turin "San Luigi" Hospital, Orbassano, Turin, Italy.
authors.forename: Roberto M
authors.initials: RM
authors.lastname: Scarpa
mesh_terms: D000310:Adrenal Gland Neoplasms / Q000601:surgery; D000315:Adrenalectomy / Q000379:methods*; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000517:prevention & control; D010535:Laparoscopy / Q000379:methods; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D061214:Patient Safety; D011446:Prospective Studies; D012187:Retroperitoneal Space / Q000601:surgery; D013514:Surgical Procedures, Operative; D011795:Surveys and Questionnaires; D016896:Treatment Outcome