Author’s reply: are adrenal lesions of 6 cm or more in diameter a contraindication to laparoscopic adrenalectomy? A case control study

We would thank Dr. Comandatore and co-authors for their interest in our article [1]. We truly appreciate their interesting ‘‘Letter to the Editor’’ and to share with us the idea to extend the minimally invasive approach also in case of challenging adrenalectomies, at least as first attempt. Our series reports a long experience of almost 25 years of laparoscopic adrenalectomy, proving its feasibility and safety also in case of large adrenal masses [1]. However, some issues emerge from our study such as an increase in the operative time and conversion rate, with differences that however did not reach statistical significance [1]. These results have to be interpreted considering the long study period and the wide surgeons’ experience [1–3]. However, we cannot refrain from considering the importance of new technological developments in minimally invasive surgery, which could contribute to reduce the differences in outcomes after adrenalectomy for small and large masses and in surgeons’ skilfulness.