Which patients are suitable candidates for laparoscopic adrenalectomy with needlescopic instruments?

Laparoscopic adrenalectomy has become the standard surgical procedure for benign adrenal tumors. The benefits of this type of surgery are reduced blood loss and postoperative pain, improved cosmetic outcomes and a reduced hospital stay. All these features could potentially be improved further by use of needlescopic instruments, which have diameters < or =3 mm, in contrast to the 5-12 mm diameters of standard laparoscopic instruments. Liao and colleagues have presented comprehensive and objective results for laparoscopic adrenalectomy with needlescopic instruments (LANI) performed in 112 patients with presumptively benign adrenal tumors <5 cm in diameter. Their results provide evidence to support the use of LANI in this setting and show that the technique is feasible for surgeons who have extensive experience in performing laparoscopic surgery. Prospective comparisons of LANI with traditional laparoscopic adrenalectomy are awaited.