There is an increasing trend towards centralisation of subspecialty procedures in the modern era, while equitable access to surgical care remains a challenge for regional and rural populations. This study reviews the experience of a general surgeon practicing in regional New South Wales, Australia, on elective adrenal surgery over fifteen years.

All patients undergoing open or laparoscopic adrenalectomy at Gosford Public and Private Hospitals, in regional New South Wales, Australia, between January 2009 and December 2023 were retrospectively analysed using prospectively maintained databases. Morbidity and mortality outcomes were reviewed.

Over a fifteen-year period, a total of 25 patients underwent adrenalectomy. Twenty-four patients were included for analysis. One patient underwent emergency adrenalectomy in the trauma setting and was excluded for analysis. The median age was 58.5 years (IQR, 54.5 – 68.5 years), with 12 (50%) being female and 14 (58%) with ASA scores of 3 or more. Twenty-three patients underwent a laparoscopic procedure, with a lateral transperitoneal approach. One patient underwent a planned open procedure, with an anterior approach, for isolated adrenal metastases. Sixteen (67%) patients underwent left-sided adrenalectomy, and 8 (33%) right-sided adrenalectomy. The majority of patients underwent adrenalectomy for benign lesions, with the leading indication being Conn’s syndrome (primary hyperaldosterolism) (9/24, 38%). Mean length of stay was 2 days (IQR, 2 – 3 days). There were no significant postoperative complications (Clavien-Dindo III or more) and no mortalities within 30 days from surgery.

This study represent the second and largest Australian series of adrenalectomy in the regional setting. With appropriate patient selection and surgeon expertise, adrenalectomy can be safely performed in provincial centres. Local referral pathways should be optimised to facilitate timely access for regional populations.