title: Laparoscopic adrenalectomy--10-year experience at a teaching hospital.
abstract: BACKGROUND
  Minimally invasive adrenalectomy has been adopted as the treatment of choice for benign adrenal tumors. This study aimed to investigate the outcome of laparoscopic adrenalectomies performed over a 10-year period at a teaching hospital.
  
  
  METHODS
  All laparoscopic adrenalectomies carried out between 1 April 2000 and 31 March 2010 were evaluated with respect to perioperative management, complications, conversion rate, learning curve, tumor size, and surgically relevant characteristics of different adrenal pathologies.
  
  
  RESULTS
  Over a period of 10 years, 215 laparoscopic lateral transabdominal adrenalectomies were carried out for Conn's syndrome (n = 90), Cushing's syndrome (n = 72), pheochromocytoma (n = 30), metastatic disease (n = 8), incidentalomas (n = 10), and other rare adrenal pathologies (n = 5). Morbidity, mortality, and conversion rate were 7.0, 0.9, and 4.2 %, respectively. Patients with Cushing's disease and bilateral adrenalectomy showed a higher complication rate. In retrospect, the indication for a laparoscopic approach was at least questionable in five cases. During these 10 years, four surgeons unfamiliar with the technique received intensive training to a defined plan.
  
  
  CONCLUSIONS
  Laparoscopic adrenalectomy represents a safe operating technique associated with few complications and a low conversion rate. Patients with severe Cushing's disease are prone to complications and require intensive monitoring postoperatively. Laparoscopic adrenalectomy is associated with a learning curve, and particular emphasis should be given to surgical training.
authors.affiliation: Department of Surgery, Innenstadt Medical Campus, Ludwig-Maximilians University, Nussbaumstrasse 20, 80336, Munich, Germany.
authors.forename: Sandra
authors.initials: S
authors.lastname: Sommerey
authors.forename: Yalda
authors.initials: Y
authors.lastname: Foroghi
authors.forename: Costanza
authors.initials: C
authors.lastname: Chiapponi
authors.forename: Sebastian F
authors.initials: SF
authors.lastname: Baumbach
authors.forename: Klaus K J
authors.initials: KK
authors.lastname: Hallfeldt
authors.forename: Roland
authors.initials: R
authors.lastname: Ladurner
authors.forename: Julia K S
authors.initials: JK
authors.lastname: Gallwas
mesh_terms: D000307:Adrenal Gland Diseases / Q000601:surgery*; D000315:Adrenalectomy / Q000193:education / Q000379:methods*; D000328:Adult; D000368:Aged; D005260:Female; D006784:Hospitals, Teaching; D006801:Humans; D010535:Laparoscopy / Q000193:education / Q000379:methods*; D059032:Learning Curve; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D016896:Treatment Outcome