title: Safety and feasibility of laparoscopic adrenalectomy: What is the role of tumour size? A single institution experience.
abstract: BACKGROUND
  Although, there are studies in the literature having shown the feasibility and safety of laparoscopic adrenalectomy, there are still debates for tumour size and the requirement of the minimal invasive approach. Our hypothesis was that the use of laparoscopy facilitates minimally invasive resection of large adrenal tumours regardless of tumour size.
  
  
  METHODS
  Within 7 years, 149 patients underwent laparoscopic adrenalectomy at one institution. The patients were divided into two study groups according to tumour size. Group 1 included patients with adrenal tumours smaller than 5 cm and group 2 included larger than 5 cm. Patient demographics and clinical parameters, operative time, complications, hospital stay and final pathology were analysed. Statistical analyses of clinical and perioperative parameters were performed using Student's t-test and Chi-square tests.
  
  
  RESULTS
  There were 88 patients in group 1 and 70 in group 2. There were no significant differences between study groups regarding patient demographics, operative time, hospital stay, and complications. Estimated blood loss was significantly higher in group 2 (P = 0.002). The conversion to open rate was similar between study groups with 5.6% versus 4.2%, respectively. Pathology was similar between groups.
  
  
  CONCLUSIONS
  Our study shows that the use laparoscopy for adrenal tumours larger than 5 cm is a safe and feasible technique. Laparoscopic adrenalectomy is our preferred minimally invasive surgical approach for removing large adrenal tumours.
authors.affiliation: Department of General Surgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.
authors.forename: Nihat
authors.initials: N
authors.lastname: Aksakal
authors.affiliation: Department of General Surgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.
authors.forename: Orhan
authors.initials: O
authors.lastname: Agcaoglu
authors.affiliation: Department of General Surgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.
authors.forename: Umut
authors.initials: U
authors.lastname: Barbaros
authors.affiliation: Department of General Surgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.
authors.forename: Mustafa
authors.initials: M
authors.lastname: Tukenmez
authors.affiliation: Department of General Surgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.
authors.forename: Selim
authors.initials: S
authors.lastname: Dogan
authors.affiliation: Department of General Surgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.
authors.forename: Berkay
authors.initials: B
authors.lastname: Kilic
authors.affiliation: Department of General Surgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.
authors.forename: Yesim
authors.initials: Y
authors.lastname: Erbil
authors.affiliation: Department of General Surgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.
authors.forename: Ridvan
authors.initials: R
authors.lastname: Seven
authors.affiliation: Department of General Surgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.
authors.forename: Selcuk
authors.initials: S
authors.lastname: Ozarmagan
authors.affiliation: Department of General Surgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.
authors.forename: Selcuk
authors.initials: S
authors.lastname: Mercan
keywords: Adrenal tumours; laparoscopic adrenalectomy; laparoscopic surgery; large tumours