Prospective comparison of early and late experience with laparoscopic adrenalectomy

Background Laparoscopic adrenalectomy has gained acceptance in the treatment of adrenal tumors. We examine our initial 73 patients and highlight the change in patient selection and outcome that experience brings. Methods A prospective study from 2000 to 2005 enrolled 73 consecutive laparoscopic adrenalectomy patients at the University of British Columbia and Vancouver General Hospitals. Results Forty patients in an initial cohort and 33 in the follow-up group underwent adrenalectomy. The follow-up group had a greater proportion of pheochromocytomas (33.3% versus 7.5%), larger tumors (4.25 versus 1.97 cm), and higher American Society of Anesthesiologist (ASA) scores (2.82 versus 2.38) and lengths of stay (2.35 versus 1.55 days). Minor complication rates (12% versus 5%) were also higher. Operative times and blood loss were similar. Pheochromocytoma was associated with higher ASA scores and longer lengths of stay. Operative times and blood loss were not affected by diagnosis. Conclusions Increasing experience in laparoscopic adrenalectomy allows broadening of indications to include a sicker patient population.