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Complications in laparoscopic adrenalectomy: the value of experience

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Abstract

Background

With the increased diffusion of laparoscopic adrenalectomy (LA), surgeons from nonreferral surgical departments are beginning to approach this procedure, even if they are less experienced than surgeons from centers with a larger workflow. This study was designed to establish the real incidence of perioperative complications, in LA, in both major and minor surgical departments.

Methods

Patients were prospectively recorded into the Italian Registry of Endoscopic Surgery-Adrenalectomy (IRES-A) database since January 2000. Surgical Centers were divided in to referral centers (RC) with >30 adrenalectomies and nonreferral centers (NRC) with <30 adrenalectomies performed. Peri- and postoperative complications were evaluated.

Results

Of the 833 patients included in the IRES-A, 66 patients (7.9%) had complications (33 females; mean age 48 ± 8 years). Mean age and body mass index were significantly lower in noncomplicated patients. Pheochromocytoma histotype and large mass dimension were associated with a higher complication rate. The whole number of complications, conversion rate, and nonsurgery-related complications were statistically lower in the RC groups than the NRC groups.

Conclusions

The main risk factors for the occurrence of complications during laparoscopic adrenalectomy appear to be surgical inexperience, age, and body mass index of the patient, the dimension of the mass, and pheochromocytoma. Therefore, laparoscopic adrenalectomy, especially for tumors that are potentially more complicated, should only be undertaken in high-volume specialist centers by surgeons with the appropriate training and experience.

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Acknowledgments

The authors thank Riccardo Rosati, Paolo Miccoli, Nicola Basso, Gianfranco Silecchia, Felice Borghi, Gianluigi Melotti, Micaela Piccoli, Rocco Bellantone, and all the SICE members who contributed to the present work.

Disclosures

Carlo Bergamini, Jacopo Martellucci, Fabiano Tozzi, and Andrea Valeri have no conflict of interest to be disclosed. No financial support was obtained for the present work.

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Authors and Affiliations

  1. General, Emergency and Mini-invasive Surgery, Careggi Hospital, Largo Brambilla 3, 50141, Florence, Italy

    Carlo Bergamini, Jacopo Martellucci, Fabiano Tozzi & Andrea Valeri

Authors
  1. Carlo Bergamini
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  2. Jacopo Martellucci
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  3. Fabiano Tozzi
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  4. Andrea Valeri
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Corresponding author

Correspondence to Carlo Bergamini.

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Bergamini, C., Martellucci, J., Tozzi, F. et al. Complications in laparoscopic adrenalectomy: the value of experience. Surg Endosc 25, 3845–3851 (2011). https://doi.org/10.1007/s00464-011-1804-0

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  • DOI: https://doi.org/10.1007/s00464-011-1804-0

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