{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,22]],"date-time":"2026-07-22T10:18:49Z","timestamp":1784715529020,"version":"3.55.0"},"reference-count":52,"publisher":"MDPI AG","issue":"13","license":[{"start":{"date-parts":[[2023,6,29]],"date-time":"2023-06-29T00:00:00Z","timestamp":1687996800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Laparoscopic adrenalectomy (LA), which avoids large abdomen incisions, is considered the gold standard technique for the treatment of benign small- and medium-size adrenal masses (&lt;6 cm) and weighing &lt; 100 g. A trascurable mortality and morbidity rate, short hospitalization and patient rapid recovery are the main advantages compared to traditional surgery. During the past decade, a new surgical technology has been developed that expedites a \u201cclipless\u201d adrenalectomy. Here, the authors analyze a clinical series of 254 consecutive patients who were affected by adrenal gland neoplasms and underwent LA by the transabdominal lateral approach over the two last decades. A literature review is also presented. Methods: Preoperative, intraoperative and postoperative data from 254 patients who underwent LA between January 2003 and December 2022 were retrospectively collected and reviewed. Diagnosis was obtained on the basis of clinical examination, laboratory values and imaging techniques. Doxazosin was preoperatively administered in the case of pheochromocytoma (PCC) while spironolactone and potassium were employed to treat Conn\u2019s disease. The same surgeon (CG) performed all the LA and utilized the same laparoscopic transabdominal lateral approach. Different dissection tools\u2014ultrasonic, bipolar or mixed scissors\u2014and hemostatic agents were used during this period. The following results were obtained: 254 patients were included in the study; functioning tumors were diagnosed in 155 patients, 52 patients were affected by PCCs, 55 by Conn\u2019s disease, 48 by Cushing\u2019s disease. Surgery mean operative time was 137.33 min (range 100\u2013180 min) during the learning curve adrenalectomies and 98.5 min (range 70\u2013180) in subsequent procedures. Mean blood loss was respectively 160.2 mL (range 60\u2013280) and 96.98 mL (range 50\u2013280) in the first 30 procedures and the subsequent ones. Only three conversions (1.18%) to open surgery occurred. No mortality or postoperative major complications were observed, while minor complications occurred in 19 patients (3.54%). In 153 out of 155 functioning neoplasms, LA was effective in the normalization of the endocrine profile. According to our experience, a learning curve consisting of 30 cases was identified. In fact, a lower operative time and a lower complication rate was reported following 30 LA. Conclusions: LA is a safe procedure, even for masses larger than 6 cm and PCCs. Undoubtedly, the development of surgical technology has made it possible reducing operative times, performing a \u201cclipless\u201d adrenalectomy and extending the indications in the treatment of more complex patients. A multidisciplinary team, in referral high-volume centers, is recommended in the management of adrenal pathology. A 30-procedure learning curve is necessary to improve surgical outcomes.<\/jats:p>","DOI":"10.3390\/jcm12134384","type":"journal-article","created":{"date-parts":[[2023,6,30]],"date-time":"2023-06-30T01:02:41Z","timestamp":1688086961000},"page":"4384","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["Impact of Current Technology in Laparoscopic Adrenalectomy: 20 Years of Experience in the Treatment of 254 Consecutive Clinical Cases"],"prefix":"10.3390","volume":"12","author":[{"given":"Giovanni","family":"Conzo","sequence":"first","affiliation":[{"name":"Division of General, Oncological, Mini-Invasive and Obesity Surgery, Department of Traslational Medical Sciences, University of Campania \u201cLuigi Vanvitelli\u201d, 80131 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6969-4157","authenticated-orcid":false,"given":"Renato","family":"Patrone","sequence":"additional","affiliation":[{"name":"Dieti Department, University of Naples Federico II, 80100 Naples, Italy"},{"name":"Division of Hepatobiliary Surgical Oncology, Istituto Nazionale Tumori IRCCS Fondazione Pascale-IRCCS di Napoli, 80131 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luigi","family":"Flagiello","sequence":"additional","affiliation":[{"name":"Division of General, Oncological, Mini-Invasive and Obesity Surgery, Department of Traslational Medical Sciences, University of Campania \u201cLuigi Vanvitelli\u201d, 80131 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio","family":"Catauro","sequence":"additional","affiliation":[{"name":"Division of General, Oncological, Mini-Invasive and Obesity Surgery, Department of Traslational Medical Sciences, University of Campania \u201cLuigi Vanvitelli\u201d, 80131 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessandra","family":"Conzo","sequence":"additional","affiliation":[{"name":"Division of General, Oncological, Mini-Invasive and Obesity Surgery, Department of Traslational Medical Sciences, University of Campania \u201cLuigi Vanvitelli\u201d, 80131 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chiara","family":"Cacciatore","sequence":"additional","affiliation":[{"name":"Division of General, Oncological, Mini-Invasive and Obesity Surgery, Department of Traslational Medical Sciences, University of Campania \u201cLuigi Vanvitelli\u201d, 80131 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4980-0335","authenticated-orcid":false,"given":"Federico Maria","family":"Mongardini","sequence":"additional","affiliation":[{"name":"Division of General, Oncological, Mini-Invasive and Obesity Surgery, Department of Traslational Medical Sciences, University of Campania \u201cLuigi Vanvitelli\u201d, 80131 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giovanni","family":"Cozzolino","sequence":"additional","affiliation":[{"name":"Division of General, Oncological, Mini-Invasive and Obesity Surgery, Department of Traslational Medical Sciences, University of Campania \u201cLuigi Vanvitelli\u201d, 80131 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rosetta","family":"Esposito","sequence":"additional","affiliation":[{"name":"Division of General, Oncological, Mini-Invasive and Obesity Surgery, Department of Traslational Medical Sciences, University of Campania \u201cLuigi Vanvitelli\u201d, 80131 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniela","family":"Pasquali","sequence":"additional","affiliation":[{"name":"Department of Advanced Medical and Surgical Sciences, University of Campania \u201cLuigi Vanvitelli\u201d, 80100 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4748-321X","authenticated-orcid":false,"given":"Giuseppe","family":"Bellastella","sequence":"additional","affiliation":[{"name":"Division of Endocrinology and Metabolic Diseases, Department of Medical, Surgical, Neurological, Metabolic Sciences and Aging, Second University of Naples, 80138 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katherine","family":"Esposito","sequence":"additional","affiliation":[{"name":"Diabetes Unit, Department of Clinical and Experimental Medicine, Second University of Naples, 80138 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ludovico","family":"Docimo","sequence":"additional","affiliation":[{"name":"Division of General, Oncological, Mini-Invasive and Obesity Surgery, Department of Traslational Medical Sciences, University of Campania \u201cLuigi Vanvitelli\u201d, 80131 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,6,29]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"G1","DOI":"10.1530\/EJE-16-0467","article-title":"Management of adrenal incidentalomas: European Society of Endocrinology Clinical Practice Guideline in collaboration with the European Network for the Study of Adrenal Tumors","volume":"175","author":"Fassnacht","year":"2016","journal-title":"Eur. 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