Complications in laparoscopic adrenalectomy: the value of experience

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.

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.

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.

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.