Adrenal surgery before and after the introduction of laparoscopic adrenalectomy

Background: The widespread introduction of laparoscopic adrenalectomy (LA) may have broadened the indications for a surgical approach to adrenal lesions. The aim of this study was to evaluate how the introduction of the laparoscopic technique changed the profile of patients referred for adrenal surgery. Methods: Some 243 patients, who underwent adrenal surgery between November 1986 and December 1999, were divided in two groups: patients in group 1 underwent surgery before the introduction of LA (November 1986 to May 1993) and those in group 2 were operated on after the introduction of LA (June 1993 to December 1999). The groups were compared with respect to gender, age, preoperative diagnosis and lesion size. Results: There were 88 patients in group 1 and 155 in group 2. The mean number of adrenal operations per month was 1.1 during the first period and 2.0 during the second. No differences were found in gender and lesion size. The statistical analysis showed a significant difference in indications for surgery (P = 0.005). The patients in group 2 were older but, after excluding those with metastases, the difference between the two groups was not significant. Conclusions: The introduction of LA resulted in an increase in the number of patients referred. The criteria for patient selection did not change, but more patients with adrenal metastases and incidentaloma were operated on laparoscopically.