Endoscopische bijnierchirurgie: naar een nieuwe standaard in 10 jaar

Description of the development of endoscopic adrenal surgery and the introduction of this procedure in Groningen University Hospital (GUH) and in the rest of the Netherlands.

Design

Literature overview, description of own results and results of a national survey.

Method

Medline was searched with the search terms: ‘laparoscopic’, ‘endoscopic’ and ‘adrenalectomy’ for the period 1992-2001. During the period January 1998-July 2001, 39 patients underwent adrenal surgery at the GUH. A questionaire about adrenal surgery was sent to 41 Dutch hospitals which provide surgical training.

Results

A total of 37 literature references were found, mostly prospective studies with a maximum of 130 patients, sometimes in retrospective comparison with conventional open surgery. No randomised studies were found. In the patient group at the GUH, 32 of the 39 patients had the adrenal gland removed endoscopically (82). There were 3 (8) primary open procedures due to tumour size (mean: 13 cm) and 4 (11) conversions (mean tumour size: 6 cm). After 32 procedures, there was still a trend towards a shorter operation time. The response to the national survey was 88 (36/41). In 9 of the hospitals no adrenal surgery was performed. In the remaining hospitals minimally invasive adrenal surgery took place in about two-thirds of the patients, mainly via the retroperitoneal route (63). More procedures were carried out in the university hospitals (mean: 11.6 per year) than in the non-university hospitals (mean: 2.9 per year). There were few concrete arrangements concerning the concentration of this technically demanding and rare procedure.

Conclusion

Over the last 10 years endoscopic adrenalectomy has developed to become the new standard for the surgical removal of benign adrenal tumours with a diameter < 10 cm. Although the procedure has an evident learning curve, there are still few concrete arrangements in the Netherlands concerning the necessary concentration of this difficult and rare technique.