Laparoscopic adrenalectomy by transabdominal lateral approach: 20 years of experience.

Laparoscopic adrenalectomy (LA) has become the standard technique for most indications. The aim of this study was to determine the predictive factors of intra- and postoperative complications in order to inform the orientation of patient to a surgeon with more experience in adrenal surgery.

From January 1994 to December 2013, 520 consecutive patients benefited from LA at Huriez Hospital, Lille, France. Each complication was graded according to the Dindo-Clavien-grade scale. The predictive factors of complications were determined by logistic regression.

Fifty-two surgeons under the supervision of 5 senior surgeons (individual experience >30 LA) participated. Postoperative complications with a grade of ≥2 occurred in 52 (10 %) patients (29 (5.6 %) medical, 19 (3.6 %) surgical, and 4 (0.8 %) mixed complications) leading to 12 (2.3 %) reoperations. There was no postoperative death. Intraoperative complication happened in 81 (15.6 %) patients responsible for conversion to open adrenalectomy (OA) [odds ratio (OR) 13.9, CI 95 % 4.74-40.77, p < 0.001]. History of upper mesocolic or retroperitoneal surgery was predictive of intraoperative complication (OR 2.02, 1.05-3.91, p = 0.036). Lesion diameter ≥45 mm was predictive of intraoperative complication (OR 1.94, 1.19-3.15, p = 0.008), conversion to OA (OR 7.46, 2.18-25.47, p = 0.001), and adrenal capsular breach (OR 4.416, 1.628-11.983, p = 0.004). Conversion to OA was the main predictive factor of postoperative complications (OR 5.42, 1.83-16.01, p = 0.002). Under adequate supervision, the surgeon's individual experience and initial adrenal disease were not considered predictive of complications.

Lesion diameter over 45 mm is the determinant parameter for guidance of patients to surgeons with more extensive experience.

Surgical endoscopy. 2016 Nov 10 [Epub ahead of print]

Thibaut Coste, Robert Caiazzo, Fanelly Torres, Marie Christine Vantyghem, Bruno Carnaille, François Pattou, Christine Do Cao, Claire Douillard

Department of General and Endocrine Surgery, CHU Lille, Rue Michel Polonovski, 59000, Lille, France., Department of Endocrinology, CHU Lille, 59000, Lille, France., Department of General and Endocrine Surgery, CHU Lille, Rue Michel Polonovski, 59000, Lille, France. .