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Patryk Fiszer, Sadegh Toutounchi, Ryszard Pogorzelski, Ewa Krajewska, Witold Cieśla and Maciej Skórski

Laparoscopic Adrenalectomy - Assessing the Learning Curve

Laparoscopic adrenalectomy (LA) has become the "gold standard" for treatment of most of adrenal tumors in last few years. It has many benefits comparing to open surgery, but still is considered as complicated procedure requiring experienced surgical team.

The aim of the study was to assess the learning curve of laparoscopic adrenalectomy and the outcome of the first consecutive 154 LA.

Material and methods. 154 consecutive patients undergoing LA between 2007 and 2010 were reviewed. Collected data included: patients demographics, clinical and histological diagnosis, side and length of operation, conversions to open surgery, complications and hospitalization time. Learning curve was evaluated by dividing all patients into three groups (group I - first 50 patients, group II - second 50 patients and group III last 54 patients). Differences between the groups were analyzed.

Results. There were 154 LAs performed. Indications for LA were hormonally inactive adrenal adenoma(n=57), Conn's syndrome (n=30), Cushing's syndrome (n=28), pheochromocytoma (n=27), adrenal cyst (n=8), and others (n=4). Mean tumor size was 45.28 mm. There were 79 left-sided and 75 right-sided procedures and the average time of hospitalization was 4.64 days. Mean operative time was statistically different between the groups (216.2 min. - 164.6 min. - 131.9 min.; p<0.01) as well as the number of conversions to open surgery (18% - 4% - 3.7%; p=0.013). There was not any significant difference in the number of complications between analyzed groups (2% - 2% -3.7%).

Conclusion. To improve the outcome of LA it is necessary to perform approximately 40 to 50 procedures.

Open access

Ewa Krajewska, Sadegh Toutounchi, Patryk Fiszer, Witold Cieśla, Ryszard Pogorzelski, Tomasz Bednarczuk, Andrzej Cieszanowski, Izabela Łoń and Maciej Skórski

Adrenal Tumors - Diagnostics and the Factual Situation

The study presented three cases of patients diagnosed with adrenal tumors subject to surgical intervention during the past 6 months in our Department. The patients presented with radiological diagnostic difficulties, as to the character and location of the primary tumor.

The aim of the study was to demonstrate differences between radiological examination results and the factual situation observed during the adrenalectomy. In all the presented cases patients' were subject to laparoscopic intervention. In two cases conversion to open surgery was necessary. The histopathological results of the surgically removed samples were as follows: leiomyoma, myoperycytoma and pheochromocytoma. In selected cases imaging examinations might be of limited value, especially when determining the character and location of the primary lesion of the adrenal gland.