Endocrine Abstracts

Introduction: National audits suggest significant variation in experience of individual surgeons performing adrenalectomies. A 2016 cross specialty consensus statement recommended that adrenal surgeons perform a minimum of six adrenalectomies per year given improved outcomes with higher volume surgeons. Patients in the Scottish Highlands requiring adrenalectomy are referred to a single Consultant Urologist with a specialist interest in retroperitoneal surgery based in Raigmore Hospital, Inverness. We sought to audit our adrenalectomy practice.

Methods: A list of adult patients having undergone adrenalectomy was obtained. Raw data on demographics, indication for and details of surgery, complications and pathology was collected from Scottish Care Information store and case records. Descriptive statistics were performed.

Results: 40 adrenalectomies were performed between 2004 and 2019, with a mean of 5.4 per year over the last five years. Indications included non-functioning incidental lesions (27.5%), hypercortisolism (20%), primary hyperaldosteronism (20%), phaeochromocytoma (17.5%) and malignancy (15%). 80% were performed laparoscopically, 15% were planned open procedures and 5% were converted to open intraoperatively. 25% had postoperative complications, of which 5% were grade I (temporary LFT derangement and urinary retention) and 20% were grade II (blood transfusions, hypertension, acute kidney injury and infections). No patients had grade III-V complications. Mean length of stay was 4.1 days after laparoscopic procedures and 10 days after open procedures. The 30-day mortality rate was 0%.

Conclusion: Whilst not meeting the 6 adrenalectomy threshold for a high volume surgeon, our results were reassuring. Length of stay was comparable to high volume surgeons in national audits. Urologists who perform a high volume of laparoscopic retroperitoneal procedures have valuable experience and may have comparable outcomes to endocrine surgeons who perform adrenal surgery. There are strong arguments for centralisation of adrenalectomies to higher volume surgeons, but this decision could have a significant impact on patients from remote and rural communities.