title: Laparoscopic adrenalectomy for adrenal tumors: a 21-year single-institution experience.
abstract: OBJECTIVE
  We have performed laparoscopic adrenalectomy including retroperitoneoscopic adrenalectomy via a single large port (RASLP) and conventional laparoscopic adrenalectomy (CLA) for adrenal tumors since 1992, and report our experience to date.
  
  
  METHODS
  The study population consisted of 134 patients who underwent laparoscopic adrenalectomy from 1992 to 2012. Fifty-eight patients (18 aldosterone-producing adenomas, 13 adenomas with Cushing's syndrome, 1 adenoma with preclinical Cushing's syndrome, and 26 nonfunctioning tumors) were treated using RASLP, and 76 patients (33 aldosterone-producing adenomas, 17 adenomas with Cushing's syndrome, 6 adenomas with preclinical Cushing's syndrome, 17 pheochromocytomas, and 3 nonfunctioning tumors) were treated using CLA. Complications were graded according to the modified Clavien system.
  
  
  RESULTS
  The majority of RASLPs were performed during the 1990s, whereas all patients underwent CLA after 2000. The mean operation times (166 vs. 205 minutes, p < 0.01) and intraoperative estimated blood loss (85 vs. 247 mL, p < 0.01) were significantly lower in the CLA group. Conversion to open surgery was required in three patients (5%) in the RASLP group and five patients (7%) in the CLA group (p = 0.73). Postoperative complications were grade 1 in three patients and grades 4 and 5 in one patient each in the RASLP group, whereas grade 2 in one patient was observed in the CLA group (p = 0.085).
  
  
  CONCLUSIONS
  Although this study included biases such as different eras and indications, CLA resulted in decreased operative times, blood loss, and postoperative complications compared with RASLP. CLA has so far become our preferred procedure for patients with adrenal tumor in our experience.
authors.affiliation: Department of Urology, Higashimatsuyama City Municipal Hospital, Saitama, Japan. Electronic address: byd04561@nifty.com.
authors.forename: Daisaku
authors.initials: D
authors.lastname: Hirano
authors.affiliation: Department of Urology, Higashimatsuyama City Municipal Hospital, Saitama, Japan.
authors.forename: Ryo
authors.initials: R
authors.lastname: Hasegawa
authors.affiliation: Department of Urology, Nihon University School of Medicine, Tokyo, Japan.
authors.forename: Tomohiro
authors.initials: T
authors.lastname: Igarashi
authors.affiliation: Department of Urology, Nihon University School of Medicine, Tokyo, Japan.
authors.forename: Katsuhiko
authors.initials: K
authors.lastname: Satoh
authors.affiliation: Department of Urology, Nihon University School of Medicine, Tokyo, Japan.
authors.forename: Junichi
authors.initials: J
authors.lastname: Mochida
authors.affiliation: Department of Urology, Nihon University School of Medicine, Tokyo, Japan.
authors.forename: Satoru
authors.initials: S
authors.lastname: Takahashi
authors.affiliation: Department of Urology, Shonan Fujisawa Tokushukai Hospital, Kanagawa, Japan.
authors.forename: Toshio
authors.initials: T
authors.lastname: Yoshida
authors.affiliation: Department of Urology, Tokyo Rinkai Hospital, Tokyo, Japan.
authors.forename: Tadanori
authors.initials: T
authors.lastname: Saitoh
authors.affiliation: Department of Urology, Isesaki Central Clinic, Gunma, Japan.
authors.forename: Shuji
authors.initials: S
authors.lastname: Kiyotaki
authors.affiliation: Department of Urology, Akiru Municipal General Hospital, Tokyo, Japan.
authors.forename: Kiyoki
authors.initials: K
authors.lastname: Okada
mesh_terms: D000236:Adenoma / Q000601:surgery*; D000310:Adrenal Gland Neoplasms / Q000601:surgery*; D000315:Adrenalectomy / Q000379:methods*; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010673:Pheochromocytoma / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: adrenal tumor; laparoendoscopic single-site surgery; laparoscopic adrenalectomy; minimally invasive surgery