Introduction Of Laparoscopic Techniques Research Articles

Intestinal anastomoses in children: The draft decision of the Russian Symposium of Children surgeons (April 2023)

The Symposium of Pediatric Surgeons of Russia, Intestinal Anastomoses in Children, was conducted in Volgograd on April 26, 2023, with around 180 doctors in attendance. Thirty papers were presented and discussed, and 41 articles were published in the proceedings of the symposium. According to the results of a systemic analysis of a questionnaire poll of major pediatric surgeons in 75 regions of Russia, 4,558 surgeries on intestinal anastomosis formation were performed in 20212022, including 1,735 operations in newborn children (36%); their share in general pediatric surgery was less than 0.6%, and it was more than 18.6% in neonatal surgeons. The number of intestinal anastomoses formed during laparoscopic procedures increased (4.4%). Pediatric surgeons equally often used double-row nodal intestinal sutures (33.3%), single-row continuous sutures (34.6%), and different types of sutures (33.3%). A T-shaped anastomosis was performed in cases of necrotizing enterocolitis where there was a significant difference in the diameters of the intestine's inflow and outflow channels. The clip-and-drop technique was used to treat neonates with multifocal necroses. Interintestinal anastomoses were favored over enterostomies in numerous segmental resections. For duodenal obstruction, duodeno-duodenal, and duodeno-jejunal anastomoses were performed. In children with Crohn's disease and choledochal cysts, most specialists prefer operations with stapling devices. Creating a magnetic interintestinal anastomosis lowers the risk of postoperative complications and facilitates the postoperative period. Clinical observations after laparoscopic surgeries accounted for a significant proportion of complications (66%). Anastomosis failure was three times more common in planned small intestinal in older children than in emergency surgeries (1.2 and 0.4%, respectively).
 The modern stage of development of intestinal anastomosis formation techniques in children is characterized by good results, the expansion of indications for intestinal anastomosis in conditions of compromised colon or peritonitis, and the introduction of laparoscopic techniques and mechanical stapling devices with slightly poorer results.

Experience in treatment of diaphragm hernias

Hernias of the diaphragm are a common pathology that negatively affects the quality of life of patients and in some cases requires high-quality surgical correction. This pathology has a progressive course, which leads to an increase in the severity of clinical manifestations with the age of the patient. The article presents the experience of surgical treatment of hernias of the diaphragm on the basis of general surgery clinics of the military medical academy. The aim of the study is to determine the effectiveness of surgical treatment of hernias of the diaphragm in different categories of patients. The total number of treated patients was 216. All patients were operated on. Thirty-four patients underwent a sympultal laparoscopic cholecystectomy. The operation used laparoscopic access. The closest excellent and good results of clinical treatment occurred in 92% of cases, satisfactory and unsatisfactory results accounted for 5.4 and 2.7%, respectively. According to the results of the instrumental survey, 40.6 and 54%, respectively, achieved excellent and good results; Satisfactory and unsatisfactory 2.7 and 2.7%. The introduction of laparoscopic techniques in surgery has reduced the number of early and late post-operative complications in the treatment of hernias of the diaphragm. The recommendations of the American Association of Endoscopic Surgeons for the operational treatment of gastroesophageal reflux disease shows the positive effect of laparoscopic fundoplications in 8593% of patients whose medicinal therapy has proved ineffective. In general, the results of the immediate and long-term outcomes of the surgical treatment of hernias of the diaphragm at the General Surgery Clinic of Military Medical Academy showed similar results (8 figs, bibliography: 16 refs).

Laparoscopic Multiple Parenchyma-sparing Concomitant Liver Resections for Colorectal Liver Metastases.

Parenchyma-sparing concept in liver surgery has received a new incitement with the introduction of laparoscopic techniques. Multiple concomitant liver resections are a major component in the parenchyma-sparing concept. In total, 689 patients underwent laparoscopic liver resection for colorectal liver metastases from August 1998 to 2017, and 171 patients were eligible for this study. Patients were divided into 3 groups: group I with single liver resection (36 patients); group II with multiple concomitant liver resections (104 patients); group III with liver resection(s) combined with concomitant liver ablation (31 patients). Perioperative outcomes and survival were compared between the groups I and II, whereas variables of group III were presented as complementary information, avoiding statistically exigent multiple comparisons. There were 6 conversions, 0, 3 (2.9%), and 2 (6.5%), respectively in the groups I, II, and III. Median operative time was 161, 186, and 224 minute in the groups I, II, and III, respectively. Median blood loss was 300 mL in groups I and II, and 200 mL in group III. It was a tendency to higher rate of postoperative complications in the group of single resections with morbidity rate of 31%, 19%, and 23% in group I, II, and III, respectively. Median postoperative stay was 3 days in all groups. Tumor-free margin resection was achieved in 92%, 86%, and 93%, respectively in the groups I, II, III. The median weight of resected specimen was significantly lower in group II (90 vs. 257 g; P<0.001). There were no significant differences in survival between the groups. The 5-year overall survival was 31%, 42%, and 43% for groups I, II, and III, respectively. Laparoscopic multiple concomitant parenchyma-sparing liver resections provide surgical and oncologic outcomes comparable with single greater resections for multiple lesions. This approach could be recommended for a wide application in specialized hepatopancreatobiliary centers.

Laparoscopic Repair of Inguinal Hernia : Early Experience in A Tertiary Care Hospital

Background : The introduction of laparoscopic techniques has added a new dimension to groin hernia surgery. The laparoscopic repair of inguinal hernia has had a staggering beginning in the surgical arena. Laparoscopic repairs have had to compete with the current gold standard for inguinal hernia repair ie Liechtenstein repair. This study shows the results of laparoscopic inguinal hernia repair in comparison to open repair in a similar group of patients.Methods and materials : This is a prospective study done on 50 male patient of inguinal hernia aging from 18- 65years. Among 50 patients selected for study 25 patient underwent open hernioplasty and 25 patient underwent laparoscopic hernioplasty. In the laparoscopic group, in 20 patients (80%) TAPP procedure was done &amp; in 5 patients (20%) TEP procedure was done.Aims and Objective : The aim of this study is to compare the effectiveness and safety of laparoscopic and conventional open repair, in the treatment of inguinal hernia.Results : Average operating time in open procedure was 55±12 minutes, and in laparoscopic procedure 65±10 minutes. Opoid analgesics were required in 36% patient in open group and 16% in laparoscopy group. Within 7 days most of the patient (76%) in laparoscopic group returned to their normal activity, but in the open group 92% patient required more than 7 days to return to normal activity. Post operative complication like hematoma formation (8%), Testicular pain (8%), retention of urine (3%), and mesh infection (4%) was more in open repair than in laparoscopic repair. In Laparoscopic group 1patient (5%) had bladder injury, and 1 patient (5%) developed illeus.Conclusion : Early results of laparoscopic inguinal hernia repair are encouraging, but the chance of organ injury like bladder, or major vessel injury are more. So laparoscopic repair of inguinal hernia should only be practiced with adequate training and experience in laparoscopic surgery.Bangladesh Crit Care J March 2016; 4 (1): 19-22

Current Status of Laparoscopic Metabolic/Bariatric Surgery in Korea

Bariatric surgery is considered the most effective treatment modality for treatment of obesity and related comorbid conditions. Bariatric surgery was introduced in the early 1950s. However, the bariatric “revolution” occurred during the late 1990s and early 2000s, which led to an exponential increase of bariatric procedures performed. This phenomenon occurred because of three events: the rapid increase of obesity rate, the introduction of laparoscopic technique, and the role of the mass media, including the internet. In Korea, surgery for obesity started in Jan. 2003 when the first laparoscopic sleeve gastrectomy was performed by Won Woo Kim (from The Catholic University of Korea). During the same year, laparoscopic gastric bypass was performed by several surgeons at 3 different institutions. Seung Ho Choi from Yonsei University, Eung Kook Kim and Sang Kuon Lee from The Catholic University of Korea, and Kyung Yul Hur (mini-gastric bypass) from Hansol Hospital performed gastric bypass laparoscopically. The next year, LAP-BAND ® device was approved by KFDA and the first laparoscopic adjustable gastric banding was performed by Eung Kook Kim and Sang Kuon Lee from The Catholic University of Korea in Aug. 2004. In 2009, a new procedure, the duodenojejunal bypass, was first introduced in Korea, mainly for metabolic purpose. This procedure was performed by three surgeons in three different institutions, Eung Kook Kim from The Catholic University of Korea, Seung Ho Choi from Yonsei University, and Yoon Seok Heo from Inha University. In 2011, the first robotic-assisted gastric bypass was performed by Do Joong Park from Seoul National University. In 2009, the Korean Society for Metabolic and Bariatric Surgery (KSMBS) was founded and in 2012, it became an official member of the International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO).

Laparoscopy in the treatment of cancer of the corpus uteri in patients with metabolic syndrome. A case report

Today, the common term metabolic syndrome encompasses visceral (abdominal) obesity, glucose intolerance, type 2 diabetes mellitus (DM), hypertension, and dyslipidemia. In Europe, the rate of obesity mong the women ranges from 6 to 36 %. In the USA, 65 % of the adult population is overweight and 30 % is obese. High estrogen production in adipose tissue in patients with obesity has been established to increase the risk of cancer of the corpus uteri (CCU) by 4 times as compared to that in normal weight female patients. Furthermore, obese patients are at increased risk for DM that is also a risk factor for CCU. A rise in the number of obese patients leads to the population redistribution of gynecological cancer. The increasing number of patients with gynecological cancer is overweight. This patient group has an increased risk from surgery and anesthesia, a higher incidence of postoperative complications, and delayed recovery. Laparotomy increases the duration of hospital stay and the rate of wound complications. The frequency of urologic injuries in obese patients varies between 2 and 4 %. In this patient category, the rate of damage to the large vessels or bowels has also statistically significant differences. The literature highlights a number of complications specific to patients with obesity: trocar damage to anterior abdominal wall vessels, particularly to the inferior epigastric artery, urinary bladder, as well as trocar site hernia. The authors describe their experience in treating CCU patients with metabolic syndrome at the Department of Surgery for Female Reproductive System Tumors, N. N. Blokhin Russian Cancer Research Center. They demonstrate that laparoscopic extirpation of the uterus and its appendages can be performed in patients with third-degree obesity (weighing 174 kg) in Stage I CCU. It should be noted that this weight was previously regarded as an absolute contraindication to surgical treatment. Today, the active introduction of laparoscopic techniques into gynecological oncology and the improvement of anesthetic maintenance make it possible to virtually level off a contraindication to surgery, such as obesity, and to transfer it to a class of indications. An examination algorithm and the clinical features of the disease are given.

ROLE OF LAPAROSCOPY IN BLUNTABDOMINAL TRAUMA

Background: Treatment of blunt abdominal trauma requires a precise diagnosis that is not always possible with imaging techniques. The introduction of laparoscopic technique is increasingly used alternative to open surgery. Diagnostic laparoscopy with therapeutic option in stable patients is an emerging technique. Objective: To assess the efficacy of laparoscopy and its role in patients with blunt abdominal trauma. Patients and methods: 40 hemodynamically stable patients with suspicious abdominal injuries underwent diagnostic or therapeutic laparoscopy at the trauma service of Zagazig University Hospital. Inclusion criteria: hemodynamically stable patients with suspicious abdominal injuries. Exclusion criteria: penetrating abdominal trauma, marked hemodynamic instability, Patients with increased intracranial tension and Patients with general or local contra-indications for laparoscopy. Operative technique: creation of Pneumoperitonium with placement of three ports, one 10-mm for the telescope and two 5-mm trocars. If necessary, accessory trocars were inserted. A thorough exploration of the abdominal cavity was carried out. The hemoperitoneum or bowel contents were aspirated, and the lesion causing the injury was located and manged, If possible. Conversion to laparotomy was decided in cases of nonsatisfactory or incomplete abdominal examination Statistical analysis: SPSS version 15. Results: laparoscopic mangement showed results better than that of open exploration as regard postoperative pain, operative time, hospital stay and most of complications. Conclusion: Laparoscopic mangemant of haemodynamically stable blunt trauma is a promising solution which needs increasing its learning curve for optimum results. Keywords: blunt – trauma - laparoscopic.

The Belsey Mark IV: an operation with an enduring role in the management of complicated hiatal hernia

BackgroundThe Belsey Mark IV operation has been used for the management of hiatal hernia for over 40 years, but with the introduction of laparoscopic techniques its role has become questionable. To determine the current role of this procedure we present a contemporary series of patients.MethodsWe reviewed fifteen consecutive patients, mean age of 63 years, who underwent a Belsey Mark IV fundoplication for gastroesophageal reflux in the presence of a hiatal hernia in our Department from January 2005 to March 2011. Indications for the thoracic approach included paraesophageal hernias, recurrent hiatal hernias and previous upper abdominal surgery.ResultsThere was no operative mortality. Immediate postoperative morbidity included 1 case of bleeding, 1 case of pneumonia and 1 case of atrial fibrillation. The mean length of stay was 5.9 days. After a mean follow-up time of 49 months, all patients reported total or partial alleviation of their symptoms. No hernia recurrence was detected during barium swallow examination.ConclusionsThe Belsey approach is a procedure that can be useful as an alternative in selected cases when there are co-morbidities complicating the transabdominal (laparoscopic) approach.

Psychosocial and marketing challenges for Natural Orifice Transluminal Endoscopic Surgery and Laparoendoscopic Single‐site Surgery

The introduction of laparoscopic techniques in the late 1980s and early 1990s has ushered in a novel era in the surgical treatment of human diseases. Following the first laparoscopic nephrectomy done by Clayman et al . in 1991 [1], the initially noted advantages of minimally invasive urological surgery were later proved [2,3]. This soon led to the transition from novelty to the current concept of established ‘expectations’. Despite the success of conventional laparoscopic urological surgery, incisions ranging from 1 to 3 cm in length and three to five ports in number are still required. Each additional working port increases the inherent risk of bleeding, infection, concordant organ damage, hernia formation and decreased cosmetic outcome.

Patient preferences for surgical techniques: should we invest in new approaches?

The face of surgery has changed over the past two decades with the introduction of laparoscopic techniques. The majority of surgical specialties now perform minimally invasive procedures hence decreasing the scarring, pain, and infection historically associated with open surgery. To further reduce the invasiveness of surgery, new surgical techniques like Natural Orifice Transluminal Endoscopic Surgery (NOTES) and Single-Port Surgery (SPS) are under development. Despite investment from the medical device industry and enthusiasm from medical professionals, we must analyse patient preferences and expectations of these novel techniques. This analysis will help us establish the demand for such techniques and guide future resource allocation. A questionnaire-based study was derived to identify whether the concepts of innovative techniques are acceptable to the general population. Their preferences between different available surgical options were recorded along with their choices for new innovative techniques. This study was carried out face-to-face and by using an online survey. It comprised four questions based upon a hypothetical scenario of an acute appendicitis. All the data were captured in a prospective database and analysed using statistical software. A total of 750 participants from variable backgrounds took part in the study. NOTES or SPS without an established safety profile was accepted by 34.3% of patients. SPS was the most popular method followed by conventional laparoscopy. Open surgery and NOTES were the least preferred (ranked 1.78, 1.98, 2.94, and 3.27, respectively). Choosing between SPS and NOTES only, 80.6% opted for SPS, 11.8% NOTES, and 5.6% declined surgery. The most popular route of access for NOTES is oral (37.7%). Single-port surgery was the most preferred method and NOTES was the least preferred technique. This shows general acceptance of the concept of virtually scarless surgery but without using the natural orifices.

Emergency appendicectomy in the era of laparoscopy: a one-year audit

Appendicectomy for acute appendicitis is the commonest emergency surgical operation. With widespread acceptance of minimal access surgery most appendicectomies are now performed laparoscopically. The aim of this study was to assess whether the rate of normal appendicectomy has changed following the introduction of laparoscopic techniques in our institution. A retrospective study of patients having emergency appendicectomies over a 1-year period (2005) in a large teaching hospital was undertaken. A comparison of data was made from a prior study performed at the same hospital in 1988. 196 adult patients underwent appendectomies during this period. The normal appendectomy rate was 10.2% compared to 22.8% in the previous study. This rate was twice as high in women of reproductive age as compared to men. There has been widespread uptake of laparoscopic appendectomy in our hospital. This technique has reduced the rate of histologically normal appendicectomies due to intra-operative visualization of the appendix.

The best way to determine the best way to undertake a hysterectomy

Hysterectomy remains one of the most commonly performed major surgical operations in the developed world. The introduction of laparoscopic techniques to undertake this important procedure has led to a reappraisal of the indications for conventional vaginal hysterectomy (VH) and abdominal hysterectomy (AH) as well as attempts to define the role of the new procedures. Most gynaecologists and their patients would agree that the optimum procedure is the one that can be performed with the greatest safety and produce the greatest relief of symptoms and improvement in quality of life in the most cost-effective manner. How then can we best determine the risks and benefits associated with the various methods of hysterectomy? There are a number of research strategies available, and they all have been used to compare the various methods of hysterectomy. The simplest and most economic is to perform a retrospective analysis of outcomes by retrieving data from the patients’ notes. The paper by Donnez et al.1 in this issue of BJOG is an example of this type of trial. A second approach is to prospectively collect the data required according to a predetermined protocol and to collect all data at the moment the event occurs. The VALUE study2,3 is this type of trial in which a cohort of more than 37 000 women who underwent hysterectomy in England, Wales and Northern Ireland between 1994 and 1995 were studied prospectively. This large, carefully designed study reported that laparoscopic hysterectomy (LH) was associated with double the risk of operative complications associated AH. A third approach is to undertake a prospective randomised controlled trial (RCT) such as the eVALuate study.4–6 A further method of assessing the pros and cons of each method is to undertake a systematic review and meta-analysis of the relevant RCTs.7 This approach obviously requires others to have undertaken a number of suitable RCTs before such a meta-analysis can be undertaken. Each of these methods has strengths and weaknesses. Retrospective trial methodology

Fast-track und Laparoskopie - Ergänzung oder Alternative? - Kombination könnte weiteren Fortschritt bringen

The introduction of laparoscopic technique and fast track concepts have been substantial new developments in visceral surgery during the past 15 years. Common purposes of both are the reduction of operative trauma and the increase of surgical efficiency. Numerous studies involving laparoscopy also in colorectal procedures showed benefits of the new technique like less postoperative pain, earlier mobilization and oral food intake and a shorter hospital stay. Studies comparing fast track regimens with conventional perioperative patient management are still quite rare. However, similar results as in the application of laparoscopic techniques with faster postoperative rehabilitation have been documented. In studies combining fast track and laparoscopy even further improvements seem achievable.

Small bowel Diverticulitis of the Roux Loop after Gastric Bypass

The epidemic of obesity and the introduction of laparoscopic techniques have greatly increased the popularity of bariatric operations such as Roux-en-Y gastric bypass (RYGBP). Acquired diverticular disease of the small bowel is a rare condition that becomes symptomatic in about 10% of the cases. We report a 48-year-old morbidly obese woman who presented 2 months after laparoscopic RYGBP with a perforated diverticulum of the Roux loop. The diagnostic and therapeutic implications are discussed.

Non-surgical treatment of esophageal achalasia

Esophageal achalasia is an infrequent motility disorder characterized by a progressive stasis and dilation of the oesophagus; with subsequent risk of aspiration, weight loss, and malnutrition. Although the treatment of achalasia has been traditionally based on a surgical approach, especially with the introduction of laparoscopic techniques, there is still some space for a medical approach. The present article reviews the non-surgical therapeutic options for achalasia.

In‐utero intervention for hypoplastic left heart syndrome — a perinatologist's perspective

.Today,whenHLHSisdiagnosedinthenewborn,or suspected by prenatal ultrasound studies, surgicalinterventions typically take one of two directions – eitherthe multistaged reconstruction pioneered by Norwood toenable single ventricle survival or cardiac transplantation.Compassionate care, although increasingly controversial,remains an option in some centers. Although increasingsurvival rates following both multi-staged surgery ortransplant are being reported, the nature of theseinterventions is such that these children remain at lifelongrisk for cardiac and neurologic morbidity.Consideration of HLHS as a candidate for

New opportunities in the treatment of acute infectious and inflammatory diseases of the pelvic organs in women

The problem of infectious and inflammatory diseases is one of the most urgent in modern gynecology. With the introduction of laparoscopic techniques, approaches to the diagnosis and treatment of this pathology have changed. We would like to draw your attention to the analysis of our experience in the use of endovideosurgical techniques in the diagnosis and treatment of infectious and inflammatory diseases of the uterus and appendages.

Optimal teaching environment for laparoscopic ventral herniorrhaphy.

The introduction of laparoscopic techniques after residency training has created a new paradigm dependent on laparoscopic workshops. This study tested the benefit of an animate course and evaluated the role of proctoring in learning to perform laparoscopic ventral hernia repair (LVHR). Surgeons who had taken a 1-day LVHR course (n = 59) were polled to determine previous experience with laparoscopic procedures and experience with LVHR after the course. Forty-eight (81%) surgeons completing the course responded. Thirty-two (67%) surgeons had performed 179 LVHRS (mean 5.6) since the course. There were no statistically significant differences between the groups performing and not performing LVHR regarding academic/private practice (P=0.8) or opportunities to perform a ventral herniorrhaphy (P = 0.6). Fifteen (31%) surgeons were precepted in their hospital operating room by the lead author. Thirteen (87%) of precepted surgeons had performed a LVHR compared with 19 (58%) of the 33 surgeons taking the course without a precepted intervention (P = 0.05). Surgeons with experience performing laparoscopic inguinal hernia repair, Nissen fundoplication, and common bile duct exploration were more likely to perform LVHR (P=0.0001). Surgeons performing only laparoscopic cholecystectomy tended to be less likely to perform LVHR, nearing statistical significance (P=0.08). Surgeons with prior advanced laparoscopic surgery experience are thus more likely to perform LVHR after participating in a 1-day course. Surgeons precepted in their hospital operating room were also more likely to perform LVHR. Participation in an animate laboratory and a precepted experience can impact the future performance of advanced laparoscopic surgery.

A Prospective Comparison of Surgical Approach for Lateral Retroperitoneal L4-5 Fusion : Laparoscopic Versus Mini-ALIF

Study Design : We have analyzed the laparoscopic lateral retroperitoneal approach of the L4-5 interspace to the miniopen retroperitoneal approach for lateral lumbar interbody fusion. Objectives : To prospectively compare the laparoscopic lateral retroperitoneal approach of the L4-5 interspace to the miniopen retroperitoneal approach for lateral lumbar interbody fusion Summary of Background Data : The introduction of laparoscopic techniques in 1993 has stimulated a great deal of discussion regarding the risks and benefits of such minimally invasive approaches. In many centers the anterior endoscopic approach to L5-S1 has become routine. However exposure at L4-5 can be much more difficult. Materials and Methods : From 1997 to 1999 thirty eight patients were entered into a prospective study. These patients were all undergoing anterior interbody fusion at the L4-5 level. The patients were divided into two groups for analysis. Group I patients underwent anterior interbody fusion utilizing threaded interbody devices placed via laparoscopic lateral retroperitoneal approach. Group II patients underwent anterior lumbar interbody fusion using threaded interbody devices placed via a miniopen retroperitoneal approach. Results : In Group I, Operation time was 48 minutes longer than Group II (p=0.035) but there were no significant statistical differences in bleeding amount and hospitalization period. Parethesia and tingling sensation of thigh were developed in two cases of Group I patients, one case of Group II patients but they were gradually diminished. In Group I, only one cage was inserted in five cases of patients (28%) who had an inadequate exposure of L4-5 area. However, all of the patients in Group II (100%) had an adequate exposure of L4-5 area. Conclusion : The surgical results of laparoscopic technique was not superior to miniopen technique.

Comparison of three techniques for adrenalectomy

Conventional open adrenal surgery requires relatively large incisions and is associated with postoperative wound pain, intercostal neuralgia and pulmonary complications. Introduction of laparoscopic techniques has enabled development of minimally invasive adrenalectomy. A case-control study of nine open, nine transperitoneal laparoscopic and 12 retroperitoneal endoscopic adrenalectomies was done in patients who were matched for Quetelet index, adrenal disorder and size of adrenal lesion; all tumours were less than 6 cm in diameter. Conversion to open adrenalectomy was necessary in two patients having transperitoneal laparoscopic adrenalectomy and in one having retroperitoneal endoscopic adrenalectomy. Operative time was longest in transperitoneal laparoscopic adrenalectomy (P = 0.004 and P = 0.005 versus open and retroperitoneal endoscopic adrenalectomy respectively). Blood loss was least in retroperitoneal endoscopic adrenalectomy (P = 0.01 versus both other groups). End-tidal carbon dioxide increase was greater in transperitoneal laparoscopic and retroperitoneal endoscopic than in open adrenalectomy (P = 0.014 and P = 0.01 respectively). After retroperitoneal endoscopic adrenalectomy, use of analgesia was least (P = 0.0003 versus other groups). Postoperative hospital stay was shortest after retroperitoneal endoscopic adrenalectomy (P = 0.024 and P = 0.027 versus open and transperitoneal laparoscopic procedures respectively). Retroperitoneal endoscopic adrenalectomy was optimal in patients with small adrenal tumours.