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

BACKGROUND: 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.

METHODS: 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.

RESULTS: 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.

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