Surgical Endoscopy

, 23:503

Factors influencing the rising rates of adrenal surgery: analysis of a 25-year experience

  • Antonio Toniato
  • Isabella Boschin
  • Paolo Bernante
  • Mirto Foletto
  • Anna Maria Guolo
  • Maria Rosa Pelizzo
  • Giuseppe Opocher
  • Enzo Ballotta
  • Franco Mantero
Article

DOI: 10.1007/s00464-008-0061-3

Cite this article as:
Toniato, A., Boschin, I., Bernante, P. et al. Surg Endosc (2009) 23: 503. doi:10.1007/s00464-008-0061-3

Abstract

Background

Adrenal surgery has been radically changed by laparoscopy and it is reasonable to wonder whether the increase in the number of adrenalectomies is entirely justified. There is still debate on the transperitoneal versus the retroperitoneal approach, the advantages and drawbacks of which are discussed here.

Methods

Between 1983 and 2007, we performed 279 adrenalectomies in 264 consecutive patients, divided into two groups: before and after the advent of laparoscopic adrenalectomy (LA). We analyzed the factors that increased the number of adrenalectomies in recent years. The LAs were further divided into three consecutive periods and the morbidity and conversion rates, and mean operating times were compared.

Results

More procedures were performed after the advent of LA, i.e., 55 (19.7%) beforehand versus 224 (80.3%) afterwards, irrespective of the type of disease, for instance: incidentaloma, 17.6% versus 82.4% (p < 0.0001); pheochromocytoma, 20.7% versus 79.3% (p < 0.0001); Conn’s disease, 19.8% versus 80.2% (p < 0.0001); Cushing’s disease, 17.2% versus 82.8% (p < 0.0001); cortical carcinoma, 30% versus 70% (p < 0.001). Analyzing the three LA periods, operating times were the only statistically significant variable (p < 0.0001).

Conclusions

The progressive increase in the number of adrenalectomies performed is due more to a better understanding of adrenal disease than to the availability of minimally invasive techniques. The choice of a laparoscopic approach (trans- or retroperitoneal) should depend on the surgeon’s experience.

Keyword

Adrenal surgery Laparoscopy 

Copyright information

© Springer Science+Business Media, LLC 2008

Authors and Affiliations

  • Antonio Toniato
    • 1
  • Isabella Boschin
    • 2
  • Paolo Bernante
    • 2
  • Mirto Foletto
    • 2
  • Anna Maria Guolo
    • 3
  • Maria Rosa Pelizzo
    • 2
  • Giuseppe Opocher
    • 4
  • Enzo Ballotta
    • 2
  • Franco Mantero
    • 4
  1. 1.Surgical Pathology Medical and Surgical SciencesUniversity of Padua PaduaItaly
  2. 2.Department of Surgical and Gastroenterological SciencesUniversity of Padua PaduaItaly
  3. 3.Department of StatisticsUniversity of Padua PaduaItaly
  4. 4.Endocrinology Unit, Medical and Surgical SciencesUniversity of PaduaPadua Italy

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