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PubMed1991

Pituitary corticotrophs proliferate temporarily after adrenalectomy.

Relationship of corticotroph proliferation answer and survival time after adrenalectomy was examined. Corticotroph proliferation rates were detected by short-term 3H-thymidine radiolabeling, then ACTH immunostaining and autoradiography. Effect of adrenalectomy on corticotroph proliferation rate was examined in vivo and an elevation was demonstrated first on the second postoperative day, increasing on the third-fourth day postoperatively and then decreasing. Effects of different secretagogues on corticotroph proliferation were examined in short-term pituitary monolayer cultures taken from ADX rats. CRF and Forskolin treatment potentiated corticotroph proliferation in cultures taken from adrenalectomized rats, but not in the controls. We suggest that croticotroph proliferation is stimulated via the cAMP-proteinkinase A pathway, while adrenalectomy plays a permissive role.

Adrenalectomy↗

PubMed1975

Influence of adrenalectomy, total body x-irradiation and dexamethasone on the amount of CRF-granules and "classical" neurosecretory material in the rat neurohypophysis.

In 195 female Wistar rats the influence of adrenalectomy, total body X-irradiation and dexamethasone treatment on the amount of CRF-granules in the external zone of the median eminence and "classical" neurosecretory material (NSM) in the internal zone of the median and in the posterior lobe of the hypophysis has been studied. In the normal rat only very few CRF-granules occur. 15 days after adrenalectomy increased amounts of CRF-granules but normal amounts of "classical" NSM are found. X-irradiation leads to a slight diminishment of "classical" NSM in normal rats. In adrenalectomized animals X-irradiation causes no changes in the amount of "classical" NSM but a marked decrease in the amount of CRF-granules. Application of dexamethasone from the 15th to 18th day after adrenalectomy enhances the augmentation of CRF-granules in irradiated and non-irradiated rats but does not influence the amount of "classical" NSM. The findings show that no correlation exists between the quantitative changes of CRF-granules and "classical" NSM under the experimental conditions used. Therefore it is to be assumed that the release of the two substances is regulated by different control mechanisms and that the substances have a different functional significance. The observations do not exclude the possibility that CRF-granules and "classical" NSM are biochemically identical.

Adrenalectomy↗

PubMedDate not supplied

Role of bilateral adrenalectomy in Cushing's disease.

Of 206 patients with Cushing's syndrome observed from 1975 through 1991, 144 (69.9%) had pituitary-dependent Cushing's disease. Of the 110 patients who underwent pituitary surgery, 31 (28%) developed an early recurrence and 23 patients (20%) had a late relapse 1 to 5 years after primary pituitary exploration. We performed a one- or two-step total bilateral adrenalectomy in 43 patients-9 men and 34 (79.4%) women, with an average age of 47.5 years (range 13-58 years). Thirty-three of these patients had already been treated by previous transsphenoidal surgery or alternatively by external pituitary irradiation over a period of 1 to 10 years prior to adrenal surgery. Thirty-one patients underwent adrenalectomy by a double lumbar access or left lumbar and right subcostal incisions. In our series of 55 operations, perioperative complications included two splenectomies and two hemorrhages (7.3%). The early mortality rate was 3.6% (two patients). Minor complications consisted of wound infection (13.5%), bronchopneumonia or pneumothorax (four cases) with a 7- to 12-day longer hospital stay. Nelson syndrome occurred in 6 of 41 patients (14.6%). We therefore believe that bilateral adrenalectomy does play a major role in the treatment of patients with pituitary-dependent Cushing's disease unsuccessfully managed by transphenoidal surgery. It represents the definitive therapy for those patients in whom hypophysectomy was not able to provide satisfactory control of the disease.

Adolescent↗

PubMed1996

Effect of adrenalectomy on the development of a pancreatic islet lesion in fa/fa rats.

Adrenalectomy prevents development of obesity and hyperinsulinaemia in obese (fa/fa) Zucker rats, thereby implicating the hypothalamo- pituitary-adrenal axis in the pathogenesis of obesity. In this study glucose-induced insulin secretion and glucokinase activity were investigated in isolated islets from adrenalectomized and control obese and lean female rats. Islets from control fa/fa rats were more sensitive to glucose with a half-maximal effective concentration (EC50) of 6.1 +/- 2.0 mmol. 1(-1) compared with 10.6 +/- 2.7 mmol. 1(-1) for adrenalectomized fa/fa rat islets. Adrenalectomy did not alter the islet sensitivity to glucose in the lean rats (EC50 of 9.4 +/- 1.5 mmol.1(-1) and 9.3 +/- 2.0 mmol. 1(-1) for adrenalectomized and control lean rats respectively). Mannoheptulose did not inhibit insulin secretion from control obese rats; however at concentrations of 1.0 mmol. 1(-1) or more it significantly inhibited glucose-induced insulin secretion in adrenalectomized obese and lean, and control lean rat islets (P < 0.05). In adrenalectomized fa/fa islets the glucokinase Km was increased twofold compared with the control fa/fa rats (9.5 +/- 1.5 mmol. 1(-1) vs 5.0 +/- 1.5 mmol. 1(-1), respectively), but there was no significant change in glucokinase Km in the lean rat islets after adrenalectomy. Mannoheptulose (10 mmol.1(-1) caused a significant reduction in glucose phosphorylation in disrupted islets of adrenalectomized fa/fa and lean, and of control lean rats, but not of control fa/fa rats. These data demonstrate that development of abnormal regulation of glycolysis in pancreatic islet beta cells of fa/fa rats, as indicated by the insulin response to manno-heptulose and glucokinase activity, is dependent on an intact hypothalamo-pituitary-adrenal axis.

Adrenalectomy↗

PubMed1984

Kallikrein along the rabbit microdissected nephron: a micromethod for its measurement. Effect of adrenalectomy and DOCA treatment.

Active and inactive kallikrein were measured along the rabbit microdissected nephron. A sensitive and specific micromethod for the measurement of kininogenase activity was developed in order to quantify kallikrein in pieces of tubule as small as 0.3-0.5 mm. Our study confirms that active and inactive kallikrein are located to the connecting tubule (CNT). The effects on renal kallikrein of a chronic DOCA treatment and of adrenalectomy were studied. Urinary excretion of kallikrein was also monitored. After DOCA treatment, active kallikrein increased in the tubule and in urine but inactive kallikrein did not significantly change. Adrenalectomy decreased by 50% active and inactive contents of CNT, as well as reduced the excretion of total kallikrein. Kallikrein content in CNT was also measured in adrenalectomized rabbits 3 h after a single injection of either aldosterone (10 micrograms) or dexamethasone (100 micrograms). After either aldosterone or dexamethasone injections, kallikrein activities were not restored, whereas in the same animals Na-K-ATPase activity which was depressed on cortical and medullary collecting tubules after adrenalectomy returned toward normal values. These data indicate that kallikrein synthesis and activation are influenced by adrenal hormones. Renal kallikrein is, however, regulated at a much slower rate than Na+-K+-ATPase. This may suggest an indirect rather than direct action of corticosteroid hormones on kallikrein.

Adrenal Cortex Hormones↗

PubMed1979

Hypophysectomy-induced inhibition of augmented acetylcholine responses of the rat bowel following adrenalectomy and/or whole body irradiation.

Functional changes in the intestinal responsiveness to a fixed dose of acetylcholine were studied in muscle strips removed from young adult male rats previously exposed to whole body gamma radiation. In the irradiated rat the responsiveness to a fixed dose of acetylcholine was found to be augmented in the small intestine but not in the colon. Similar motor patterns for the small intestine were found when muscle strips from adrenalectomized rats were studied. Preradiation adrenalectomy further exaggerated the post-radiation sensitivity of the rat small intestine to acetylcholine. Hypophysectomy prior to either adrenalectomy and/or whole body radiation was associated with an absence of augmented small intestinal motor activity following administration of acetylcholine. The response of the large bowel to acetylcholine, however, was not modified by adrenalectomy and/or hypophysectomy. These observations suggest an endocrine component to the acute 3--5 day intestinal radiation syndrome.

Acetylcholine↗

PubMed1986

Adrenalectomy modifies the effect of intracerebral histamine on the cold-stimulated TSH secretion in male rats.

Cold-stimulated TSH secretion remained normal after adrenalectomy in conscious male Sprague-Dawley rats, but the inhibitory effect of a small dose of histamine (1.0 micrograms/rat into the 3rd ventricle, i.c.v.) on the TSH secretion was abolished. Adrenaline (0.01-1.0 mg/kg s.c.) inhibited dose-dependently the cold-stimulated TSH secretion. However, although adrenalectomy causes a prominent decrease in releasable adrenaline, a larger dose of histamine (2.5 micrograms/rat i.c.v.) decreased the TSH secretion. The effect of histamine was not modified after pretreatment with either corticosterone or dexamethasone, irrespective of whether intact or adrenalectomized rats were studied. Corticosterone decreased and dexamethasone increased the cold-stimulated TSH secretion when given intraperitoneally. Chlorisondamine (10 mg/kg i.p.), a peripheral ganglionic blocking drug, suppressed the TSH cold-response in intact rats. Histamine (1.0 microgram/rat i.c.v.) had no additional inhibitory effect after chlorisondamine. The results suggest that the effect of intracerebral histamine on cold-stimulated TSH secretion is caused neither by stimulation of the hypothalamus-pituitary-adrenocortical axis nor by increased adrenomedullary catecholamine release. Further, the effect of intracerebral histamine is obviously not due to enhanced neurosympathetic activity. The effect of histamine is modified by adrenalectomy, but the adrenal glands are not essential for it.

Adrenalectomy↗

PubMed1990

Progressive cancellous bone loss in rats after adrenalectomy and oophorectomy.

Female Sprague-Dawley rats (n = 72), 6 months old, underwent either sham operation, oophorectomy, adrenalectomy, or combined oophorectomy and adrenalectomy (O&A). They were all maintained on normal saline ad libitum and 20 g/day 1.1% calcium chow. Nine weeks after operation, the trabecular bone volume of the distal femoral shaft was significantly lower (P less than 0.001) in the adrenalectomized (11.1%), oophorectomized (7.0%), and O&A (8.3%) animals than in sham-operated animals (19.8%). Eighteen weeks after operation, the trabecular bone volume in O&A animals had fallen to a mean of 3.8% (sham 17.0%), and the length of the femur had increased to 38.8 mm after O&A (sham 36.8 mm, P less than 0.01). O&A animals treated with 0.35 mg/kg/week nandrolone decanoate from 9 weeks postoperatively onward, had twice the femoral trabecular bone volume of untreated animals at 18 weeks (P less than 0.05). By contrast, no significant differences were found in vertebral body trabecular bone between any groups, including groups receiving treatment with androgens. We have found that, by 9 weeks after operation, adrenalectomy alone causes significant loss of metaphyseal trabecular bone, similar to the progressive loss seen after oophorectomy.

Adrenal Glands↗

PubMedDate not supplied

Modification of malathion induced neurochemical changes by adrenalectomy in rats.

The neurochemical changes induced by malathion, an organophosphate compound, were determined in rats. Maximal changes were found in the brain 2 h after the administration of malathion in a dose of 500 mg/kg ip. The activities of cholinesterase and succinic dehydrogenase were reduced whereas those of glycogen phosphorylase, phosphoglucomutase, and hexokinase were increased; the lactate content of brain was also increase. In malathion treated adrenalectomized animals, changes in the activities of cerebral cholinesterase and succinic dehydrogenase were still present; other changes were, however, abolished by adrenalectomy. Activities of certain enzymes, glucose-6-phosphatase, glucose-6-phosphate dehydrogenase, and lactate dehydrogenase were not significantly altered by malathion in normal or adrenalectomized animals. The results indicate that cerebral cholinergic mechanism in malathion treated animals was not modified by adrenalectomy which, however, abolished or reduced changes in the activities of certain glycolytic and glycogenolytic enzymes that are involved in the utilization or metabolism of glucose. The brain lactate content in malathion treated adrenalectomized animals was, also, not significantly different from the control values, suggesting that modification of induced changes by adrenalectomy.

Acetylcholine↗

PubMedDate not supplied

Bilateral adrenalectomy for Cushing's syndrome: a comparison between laparoscopy and open surgery.

We report our experience with bilateral adrenalectomy for treatment of Cushing's syndrome and we compare the outcome of laparoscopy with open surgery in terms of effectiveness and safety. A series of 23 patients underwent bilateral adrenalectomy for treatment of Cushing's syndrome [Cushing's disease in 16, ectopic ACTH syndrome in 2, and ACTH-independent macronodular adrenal hyperplasia (AIMAH) in 5 cases]. From 1993 to 1996, all patients were treated using an open approach (Group A), while from 1997 all patients were treated using a transperitoneal laparoscopic approach (Group B). The comparison between the 2 groups was performed considering patients characteristics, operative times, blood losses, intraoperative and post-operative complications, analgesic consumption, post-operative hospital stay and recovery. Open surgery was performed in 10 patients and laparoscopy in 13 patients. No significant difference was recorded between the two groups as to patients' characteristics and complications. Mean operative time was significantly increased in Group B, while post-operative hospital stay was significantly longer in Group A. Laparoscopic bilateral adrenalectomy can be safely and effectively employed to treat Cushing's syndrome. However, long operatives times may represent a limitation especially in high risk patients.

Adrenalectomy↗

PubMed2003

[Is adrenalectomy an indispensable part of nephrectomy? Results of a multivariate statistical analysis].

Since in the absence of clinically overt metastatic disease tumorous lesions within the adrenal gland are found in only 2-10% of cases, the majority of renal cell cancer patients are overtreated by adrenalectomy as an integral part of nephrectomy. The medical records of 847 patients undergoing adrenalectomy in combination with nephrectomy irrespective of the local extent of the primary tumor or the clinical stage at first diagnosis were reviewed to determine the reliability of currently available imaging modalities regarding the prediction of adrenal gland metastases. Several patient and tumor characteristics correlated with the presence of intra-adrenal metastases, and their prognostic value was determined by a multivariate logistic regression model. Metastatic spread into the adrenal gland was observed in 27 of 847 (3%) patients. In only three of eight patients in whom the adrenal was identified as the only metastatic site, preoperative abdominal CT scans were interpreted as false negative. During multivariate statistical analysis, only the presence of distant metastases, vascular invasion within the primary tumor, and multifocal growth of renal cell cancer within the tumor-bearing kidney were identified to independently predict the likelihood for the presence of intra-adrenal metastases. None of the patient or tumor characteristics evaluated reliably predicted the likelihood for the presence of adrenal metastases in patients without evidence of disseminated metastatic spread. As we believe and as the current investigation demonstrates, routine adrenalectomy should not be recommended in cases of preoperatively normal radiological examinations.

Adrenal Gland Neoplasms↗

PubMed1997

Increase of 5-HT7 (serotonin-7) and 5-HT1A (serotonin-1A) receptor mRNA expression in rat hippocampus after adrenalectomy.

The brain 5-HT (serotonin) system and circulating corticosteroids are in close interaction and both are implicated in the pathogenesis of affective disorders. The 5-HT1A receptor is thought to play a major role in this relationship. However, the recently cloned 5-HT7 receptor may also be involved, given its pharmacological similarities to the 5-HT1A receptor and its high expression in corticolimbic structures. Using in situ hybridization histochemistry, we have investigated 5-HT7 and 5-HT1A receptor mRNA expression in selected areas of the rat brain 7 days post-adrenalectomy. 5-HT7 receptor mRNA was increased in CA1 and CA3b after adrenalectomy, with no alterations in other hippocampal subfields or in retrosplenial cortex. Adrenalectomy was associated with a marked increase of 5-HT1A receptor mRNA in dentate gyrus, CA3 and CA2, but not in CA1, nor in the raphe. These data indicate that circulating adrenal steroids have a inhibitory role on the expression of hippocampal 5-HT7 receptors as well as 5-HT1A receptors, but the effect upon the two transcripts occurs in different subfields. The 5-HT7 receptor is an additional candidate for mediating the interactions between 5-HT and corticosteroids within the hippocampus.

Adrenal Cortex Hormones↗

PubMed1999

Effects of adrenalectomy and gonadectomy on sex and stress-induced differences in bicuculline-induced convulsions.

The effects of adrenalectomy, gonadectomy and combined adrenalectomy plus gonadectomy on the previously described sex-dependent anticonvulsive effect of swim stress were studied in rats. The convulsive signs (myoclonic twitch, generalized convulsions, tonic hindlimb extension) were produced by constant i.v. infusion of gamma-aminobutyric acid(A) (GABA(A)) antagonist bicuculline, which started 15 min after termination of swim stress (10-min swim at 18-19 degrees C). Adrenalectomy decreased the threshold doses of bicuculline producing the first myoclonic twitch and the onset of generalized convulsions only in females. In adrenalectomized females, but not in males, swim stress enhanced the threshold dose of bicuculline producing generalized convulsions, but, unlike in adrenal-intact animals, it failed to enhance the dose of bicuculline producing tonic hindlimb extension. In gonadectomized stressed and unstressed animals all sex differences disappeared, and swim stress enhanced in both sexes only the threshold doses of bicuculline producing tonic hindlimb extension. Adrenalectomized plus gonadectomized animals displayed clear sex differences in doses of bicuculline necessary to produce all the convulsive signs. In the same animals swim stress postponed, especially in females, the onset of the first myoclonic twitch and generalized convulsions, but not the onset of tonic hindlimb extension. In summary, our results suggest that hormones of the adrenal and gonadal glands are only partly responsible for decreased susceptibility, especially of female rats, to the GABA(A) antagonist bicuculline. Moreover, they have demonstrated that stress produces a gender-specific anticonvulsive effect even in the animals completely deprived of steroid hormones of peripheral origin.

Adrenalectomy↗

PubMed2003

Expectations and outcomes when moving from open to laparoscopic adrenalectomy: multivariate analysis.

Various authors have suggested that laparoscopic adrenalectomy (LA) leads to better surgical outcomes than open surgery. The debate is still open, however, and indications and limitations of minimally invasive surgery have not been completely established. The objective of our study was to compare surgical outcomes of LA and open adrenalectomy (OA), using multivariate analysis to adjust for potential confounding factors (e.g., size of the lesion, histology). Between 1995 and June 2000 at "Careggi" Hospital in Florence, Italy patients with an indication for adrenalectomy were treated laparoscopically if the lesion was < 10 cm and there was no clinical evidence of malignancy. All 79 patients who underwent LA have been included in this study. Among 152 patients who underwent OA at "La Sapienza" University in Rome, 93 had an adrenal lesion < 10 cm and no clinical evidence of malignancy; they were selected for comparison. Multivariate analysis has been used to analyze the effect of the surgical approach (OA vs. LA) on the surgical outcome, controlling for potential confounders. Multiple logistic regression showed that there is no significant difference in intraoperative outcomes (i.e., surgical time > 2 hours, blood loss > or = 500 ml) between patients operated on through a traditional approach and those who underwent LA. On the other hand, patients operated on laparoscopically have a significantly higher probability than the OA group of experiencing a better recovery from surgery (i.e., require less postoperative analgesics and return to normal activities earlier). The results of the present study show that, although LA does not add much benefit in terms of expected intraoperative outcomes, it dramatically speeds patients' recovery from surgery. The two approaches are complementary and should both be integrated into the technical background of all endocrine surgeons.

Adrenalectomy↗

PubMed2006

Long-term outcome following laparoscopic adrenalectomy for large solid adrenal cortex tumors.

INTRODUCTION: Laparoscopic adrenalectomy (LA) is the procedure of choice for small benign adrenal tumors. In the absence of local invasion or metastases, the preoperative diagnosis of an adrenocortical carcinoma (ACC) is difficult, often leaving size as the principal predictor of malignancy. Large tumors are resectable laparoscopically, but the long-term outcome and therefore appropriateness of LA for cortical tumors > 6 cm is not known. METHODS: We reviewed the LA experience in our institution since its introduction in June 1994. Patients who underwent LA for solid cortical tumors > or = 60 mm in diameter without preoperative or intraoperative evidence of malignancy were reviewed. Follow-up data, including clinical examination, biochemical analysis, and repeat scans, were reviewed for evidence of local or systemic recurrent disease. RESULTS: Between 1994 and 2004 a total of 462 adrenalectomies were performed, 391 of which were done laparoscopically. Among them, 19 were solid cortical tumors > or = 60 mm in diameter with no overt malignant preoperative or intraoperative characteristics: 9 nonsecreting tumors, 8 Cushing's syndrome tumors (including 2 virilizing variants), 1 virilizing tumor, and 1 aldosteronoma. The mean age of the patients was 49.9 years (range 22-77 years), and the mean tumor size was 69.0 mm (range 60-80 mm). Histology confirmed a cortical adenoma in eight patients, malignant tumors in three, and indeterminate tumors in eight. The mean follow-up was 34 months (range 4-108 months). Two patients died of systemic recurrent disease (liver metastases) at 10 and 19 months, respectively, following surgery; two other patients died 12 and 21 months, respectively following surgery owing to unrelated cardiovascular and cerebrovascular pathology. One patient underwent surgery for local recurrence 54 months after primary surgery; the remaining 14 patients are well with no clinical or radiologic evidence of recurrent disease. CONCLUSIONS: Laparoscopic adrenalectomy for large solid cortical tumors without pre- or intraoperative evidence of malignancy is not contraindicated, and it is unlikely to have a deleterious effect on long-term outcome. Each case should be considered individually. We provide an algorithm for the approach to adrenocortical tumors > or = 6 cm.

Adrenal Cortex Neoplasms↗

PubMed2000

Suprasplenic, transperitoneal approach for laparoscopic adrenalectomy on the left side.

BACKGROUND: There are several minimally invasive means of exposing the adrenal glands. Each of them has its own advantages and disadvantages. A new approach was introduced for laparoscopic adrenalectomy on the left side. PATIENTS AND METHODS: Between June 1997 and January 2000, 23 transperitoneal unilateral laparoscopic adrenalectomies on the left side were performed. In 4 of these cases, only enucleation of a well-circumscribed adenoma was done. In a semilateral position, the gland was approached through the splenophrenic ligament with partial mobilization of the spleen. The left adrenal gland was quickly and safely exposed, thus avoiding the complications of transmesocolic exposure. There was no need for extensive mobilization of the spleen or the pancreas. RESULTS: In 20 cases the laparoscopic operation was successfully performed. In 3 cases conversion was necessary because of bleeding. The estimated blood loss was on average 150 ml. The mean operation time was 84 min, the mean postoperative stay 4.5 days. No other major complications were observed. CONCLUSION: This new method is a safe and quick technique for left-sided laparoscopic adrenalectomy, and it can be an alternative to the existing ones.

Adrenal Gland Diseases↗

PubMed2001

Laparoscopic adrenalectomy for pheochromocytoma.

BACKGROUND: Laparoscopic adrenalectomy for Conn's syndrome, Cushing's disease, cortisol-producing adenomas, and nonfunctioning adenomas has been well established. This study was intended to evaluate the clinical outcomes of patients undergoing laparoscopic adrenalectomy for pheochromocytoma, and to assess the efficacy and safety of a minimally invasive approach. METHODS: Data were collected prospectively on all patients undergoing laparoscopic adrenalectomy for pheochromocytoma over a 5-year period. RESULTS: In this study, 39 consecutive patients underwent laparoscopic resection of a pheochromocytoma: 38 adrenal (23 left, 15 right) and 1 extraadrenal paraganglioma. There were no conversions to open surgery. The mean tumor size was 5.2 cm (range, 2-12.1 cm). Average operative time was 159 min (range, 100-265 min), and average estimated blood loss was 72 ml (range, 30-350 ml). Intraoperative hypertension (systolic blood pressure > 170 mmHg) occurred in 67% of the patients, and hypotension (systolic blood pressure < 90 mmHg) in 39% of the patients. The mean length of stay was 2.1 days (range, 1-4 days). There were three minor postoperative complications. During a mean follow-up period of 14 months, there were no mortalities or recurrences of endocrinopathy. CONCLUSIONS: Laparoscopic resection of pheochromocytomas can be accomplished safely despite frequent episodes of hemodynamic variability equal to those of historic open control subjects. A short hospital stay with expedient recovery,minimal wound complications, and lack of endocrinopathy recurrence makes a minimally invasive approach the procedure of choice for the management of pheochromoctyoma.

Adrenalectomy↗

PubMed2003

Transition from open to laparoscopic adrenalectomy: the need for advanced training.

BACKGROUND: We sought to determine the learning curve for laparoscopic adrenalectomy (LA), current use of the procedure, and if indications for adrenalectomy had changed in the past decade. METHODS: A retrospective chart review was performed for all adrenalectomies after 1990. Practicing community surgeons in Oregon were mailed a questionnaire. RESULTS: Seventy-five LAs were performed at the Oregon Health and Sciences University and Portland VA Medical Center. Average operating room (OR) time was 161 min and average estimated blood loss (EBL) was 84 ml. There were four complications and two conversions. Comparing the first 20 to the last 20 patients, OR times were 154 vs 159 min (not significant), and EBL was 102 vs 47 ml ( p < 0.05). There were two vs one complications ( p > 0.05) and one conversion each. Most residents completed less than two procedures during training, and community surgeons performed none during training. Of 17 currently performing LA, 14 had postresidency training. Open technique was used more often for hormonal ablation and malignancy. CONCLUSION: Operative time and complications do not decrease with experience, but EBL does. Few, if any, residents acquire enough experience to perform LA in practice. The procedure is performed laparoscopically more often for benign disease.

Adrenal Gland Neoplasms↗