title: Should specific patient clinical characteristics discourage adrenal surgeons from performing laparoscopic transperitoneal adrenalectomy?
abstract: BACKGROUND
  Although laparoscopic transperitoneal adrenalectomy (LTA) has become a standard operative approach to patients with benign adrenal masses, some authors have suggested that LTA should be avoided in obese patients, patients who have had previous abdominal surgery, and in cases of bilateral adrenalectomy. We sought to determine whether LTA in these clinical situations is associated with worse outcomes.
  
  
  METHODS
  Consecutive patients who underwent LTA at a tertiary care center (1/2002-8/2014) were reviewed retrospectively. Study endpoints included operative time, duration of stay, conversion to open procedure, and postoperative complications. Statistical analyses were performed by use of Wilcoxon rank sum test, Kruskal-Wallis test, Fisher exact test, χ(2) test, and binary logistic regression analyses.
  
  
  RESULTS
  A total of 365 patients had a planned LTA, 6 of whom were converted to an open adrenalectomy. Obesity, history of previous abdominal surgery, and bilateral adrenalectomy were not associated with greater conversion rates or postoperative complications. Male sex, tumor size ≥ 4 cm and obesity (body mass index ≥ 30 kg/m(2)) were significant factors associated with increased operative time. Bilateral adrenalectomy, age, and pheochromocytomas were associated with increased hospital stays.
  
  
  CONCLUSIONS
  Obesity, history of prior abdominal surgery and bilateral adrenalectomy should not be used to discourage experienced adrenal surgeons from performing LTA.
authors.affiliation: Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
authors.forename: Konstantinos P
authors.initials: KP
authors.lastname: Economopoulos
authors.affiliation: Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
authors.forename: Roy
authors.initials: R
authors.lastname: Phitayakorn
authors.affiliation: Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
authors.forename: Carrie C
authors.initials: CC
authors.lastname: Lubitz
authors.affiliation: Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
authors.forename: Peter M
authors.initials: PM
authors.lastname: Sadow
authors.affiliation: Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
authors.forename: Sareh
authors.initials: S
authors.lastname: Parangi
authors.affiliation: Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
authors.forename: Antonia E
authors.initials: AE
authors.lastname: Stephen
authors.affiliation: Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA. Electronic address: rhodin@mgh.harvard.edu.
authors.forename: Richard A
authors.initials: RA
authors.lastname: Hodin
mesh_terms: D000307:Adrenal Gland Diseases / Q000150:complications / Q000601:surgery*; D000315:Adrenalectomy / Q000379:methods*; D000328:Adult; D000368:Aged; D000075202:Contraindications; D005260:Female; D006801:Humans; D010535:Laparoscopy; D007813:Laparotomy; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications; D012086:Reoperation; D012189:Retrospective Studies