Adrenal surgery before and after the introduction of laparoscopic adrenalectomy P. Miccoli, M. Raffaelli, P. Berti, G. Materazzi, M. Massi and G. Bernini* Departments of Surgery and *Internal Medicine, University of Pisa, Pisa, Italy Correspondence to: Dr P. Miccoli, Dipartimento di Chirurgia, Via Roma 67, 56 100 Pisa, Italy e-mail: p.miccoli@dc.med.unipi.it) 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 pro®le 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 ®rst period and 2´0 during the second. No differences were found in gender and lesion size. The statistical analysis showed a signi®cant 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 signi®cant. Conclusion: 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. Paper accepted 1 March 2002 British Journal of Surgery 2002, 89, 779±782 Introduction Since its ®rst description in 1992 1 , laparoscopic adrena- lectomy LA) has been used with increasing frequency and several studies have documented its superiority over conventionalopenadrenalectomyintermsofpostoperative recovery, hospital stay and overall cost 2±6 .Thisoperationis now considered the gold standard approach for removal of adrenal lesions 7 . Moreover, recent reports 8±14 have sug- gested that indications for LA may be broadened to include lesions such as phaeochromocytoma, metastases, and large and/or potentially malignant adrenal tumours for which a laparoscopic approach has previously been considered hazardous 15 . One possible concern about the wide application of this minimally invasive technique is that it might result in a marked change in patient selection for surgery, since both patients and endocrinologists tend to prefer surgical treatment. This is of particular concern in the case of small non-functioning incidentalomas for which surveil- lance is generally indicated 16±19 . The aim of this study was to evaluate whether the introduction of LA has resulted in a signi®cant change in indications and patient selection for adrenal surgery. Patients and methods All patients who underwent adrenal surgery in this department between 1 November 1986 and 31 December 1999 were included in the study. The medical records of these patients were reviewed and data were collected on gender, age, indication for surgery preoperative diagno- sis), preoperative estimated size of the lesion ultrasono- graphy, computed tomography CT) and magnetic resonance imaging MRI)), surgical approach and proce- dure, operative time, postoperative stay and complications, and ®nal histology. The patients were divided in two groups, according to whether they were operated on before or after the Original article ã 2002 Blackwell Science Ltd British Journal of Surgery 2002, 89, 779±782 779