title: Single center outcomes of laparoscopic transperitoneal lateral adrenalectomy--Lessons learned after 500 cases: A retrospective cohort study.
abstract: BACKGROUND
  Although laparoscopic adrenalectomy is considered relatively safe, the results of treatment vary depending on the profile of the hospital. We would like to present our experience with laparoscopic surgery of the adrenals.
  
  
  METHODS
  We conducted a retrospective cohort study of consecutive patients operated for adrenal tumours in the years 2003-2014. The study group included 175 (35%) men and 325 (65%) women. The entire group was divided into 4 cohorts of 125 consecutively operated patients. Primary outcomes were operative measures (operative time, its correlation with tumour size, blood loss, conversion rate, use of peritoneal drainage). Secondary outcomes were the intra- and postoperative complications (using the Clavien-Dindo classification), histological type of the tumours and length of hospital stay.
  
  
  RESULTS
  There were no differences between groups in terms of the size and location of the tumour. The mean operative time in each group was 85.7; 83.7; 89.6; 104.6 min (p < 0.001). The operative time correlated to the size of the tumour. There were no differences in the conversion rates as well as in the blood loss. However, it was observed that the complication rate was declining in subsequent subgroups (14.4%, 11.2%, 8% and 5.6%, respectively, p = 0.013). Length of hospital stay was 4.9 days, 3.9 days, 2.9 days, 2.4 days, respectively (p < 0.001).
  
  
  CONCLUSIONS
  The results of laparoscopic adrenalectomy depend not only on the experience of the single surgeon, but on the whole team involved in perioperative care. In high volume centers with extensive experience in surgery of adrenals, this technique may provide an alternative to open surgery, also in selected cases of malignant tumours.
authors.affiliation: Jagiellonian University, 2nd, Department of General Surgery, Kopernika 21, 31-501 Kraków, Poland. Electronic address: michal.pedziwiatr@uj.edu.pl.
authors.forename: Michał
authors.initials: M
authors.lastname: Pędziwiatr
authors.affiliation: Jagiellonian University, 2nd, Department of General Surgery, Kopernika 21, 31-501 Kraków, Poland; Jagiellonian University, Department of Physiology, Grzegórzecka 16, 31-531 Kraków, Poland.
authors.forename: Mateusz
authors.initials: M
authors.lastname: Wierdak
authors.affiliation: Jagiellonian University, Department of Urology, Grzegórzecka 18, 31-531 Kraków, Poland.
authors.forename: Mateusz
authors.initials: M
authors.lastname: Ostachowski
authors.affiliation: Jagiellonian University, 2nd, Department of General Surgery, Kopernika 21, 31-501 Kraków, Poland.
authors.forename: Michał
authors.initials: M
authors.lastname: Natkaniec
authors.affiliation: Jagiellonian University, Department of Pathology, Grzegórzecka 16, 31-531 Kraków, Poland.
authors.forename: Magdalena
authors.initials: M
authors.lastname: Białas
authors.affiliation: Jagiellonian University, Department of Endocrinology, Kopernika 16, 31-531 Kraków, Poland.
authors.forename: Alicja
authors.initials: A
authors.lastname: Hubalewska-Dydejczyk
authors.affiliation: Jagiellonian University, 2nd, Department of General Surgery, Kopernika 21, 31-501 Kraków, Poland.
authors.forename: Maciej
authors.initials: M
authors.lastname: Matłok
authors.affiliation: Jagiellonian University, 2nd, Department of General Surgery, Kopernika 21, 31-501 Kraków, Poland.
authors.forename: Piotr
authors.initials: P
authors.lastname: Major
authors.affiliation: Jagiellonian University, 2nd, Department of General Surgery, Kopernika 21, 31-501 Kraków, Poland.
authors.forename: Piotr
authors.initials: P
authors.lastname: Budzyński
authors.affiliation: Jagiellonian University, 2nd, Department of General Surgery, Kopernika 21, 31-501 Kraków, Poland.
authors.forename: Marcin
authors.initials: M
authors.lastname: Migaczewski
authors.affiliation: Jagiellonian University, 2nd, Department of General Surgery, Kopernika 21, 31-501 Kraków, Poland.
authors.forename: Andrzej
authors.initials: A
authors.lastname: Budzyński
mesh_terms: D000310:Adrenal Gland Neoplasms / Q000473:pathology / Q000601:surgery*; D000315:Adrenalectomy / Q000379:methods*; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D019990:Perioperative Care; D010537:Peritoneum / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: High volume center; Incidentaloma; Laparoscopic adrenalectomy; Learning curve; Pheochromocytoma