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Laparoscopic Adrenalectomy - Assessing the Learning Curve

100%
Fiszer P., Toutounchi S., Pogorzelski R., Krajewska E., Cieśla W., Skórski M.
Polish Journal of Surgery
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2012
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vol. 84
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issue 6
293-297
EN
Laparoscopic adrenalectomy (LA) has become the "gold standard" for treatment of most of adrenal tumors in last few years. It has many benefits comparing to open surgery, but still is considered as complicated procedure requiring experienced surgical team.The aim of the study was to assess the learning curve of laparoscopic adrenalectomy and the outcome of the first consecutive 154 LA.Material and methods. 154 consecutive patients undergoing LA between 2007 and 2010 were reviewed. Collected data included: patients demographics, clinical and histological diagnosis, side and length of operation, conversions to open surgery, complications and hospitalization time. Learning curve was evaluated by dividing all patients into three groups (group I - first 50 patients, group II - second 50 patients and group III last 54 patients). Differences between the groups were analyzed.Results. There were 154 LAs performed. Indications for LA were hormonally inactive adrenal adenoma(n=57), Conn's syndrome (n=30), Cushing's syndrome (n=28), pheochromocytoma (n=27), adrenal cyst (n=8), and others (n=4). Mean tumor size was 45.28 mm. There were 79 left-sided and 75 right-sided procedures and the average time of hospitalization was 4.64 days. Mean operative time was statistically different between the groups (216.2 min. - 164.6 min. - 131.9 min.; p<0.01) as well as the number of conversions to open surgery (18% - 4% - 3.7%; p=0.013). There was not any significant difference in the number of complications between analyzed groups (2% - 2% -3.7%).Conclusion. To improve the outcome of LA it is necessary to perform approximately 40 to 50 procedures.
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Clinical outcomes of treatment of sinonasal inverted papillomas (IPs) depending on the surgical technique and learning curve.

88%
Zydroń R., Wierzbicka M., Greczka G.
Otolaryngologia Polska
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2016
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vol. 70(6)
1-5
EN
INTRODUCTION: Sinonasal inverted papillomas (IPs) are a major challenge for ENT specialists. In the last decades, the number of endoscopic procedures has increased, while the percentage of external or double approach procedures has decreased. The aim of this study was to evaluate long-term IP treatment outcomes according to the applied surgical method. MATERIAL AND METHODS: the retrospective study included 69 patients (28 women and 41 men) treated during 2002–2012 in the Department of Otolaryngology and Laryngological Oncology of Poznań University of Medical Sciences. Of these patients, 47 were operated endoscopically, 16 received a double procedure and six received an external procedure. RESULTS: The recurrence rate in patients treated endoscopically was 32%, while patients treated by the external/double approach showed 64% (p = 0.03306). The recurrence rate after endoscopic surgery was 75% during 2002–2006, but was 28% during 2007–2012. There was no correlation between recurrence rate and age (p = 0.087686), gender (p = 0.42810), type of symptoms (p = 0.20955), or Krouse staging (p = 0.23658). A significant impact on relapses was the position to Ohngren’s plane (p = 0.004768) and tumor location in the anterior ethmoid (p = 0.00416). DISCUSSION: Endoscopic procedures are an effective method of IP treatment, however reasonable indications and surgeon experience should be taken into consideration.
3
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Clinical outcomes of treatment of sinonasal inverted papillomas (IPs) depending on the surgical technique and learning curve.

88%
Zydroń R., Wierzbicka M., Greczka G.
Polish Journal of Otolaryngology
|
2016
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vol. 70
|
issue 6
1-5
EN
INTRODUCTION: Sinonasal inverted papillomas (IPs) are a major challenge for ENT specialists. In the last decades, the number of endoscopic procedures has increased, while the percentage of external or double approach procedures has decreased. The aim of this study was to evaluate long-term IP treatment outcomes according to the applied surgical method. MATERIAL AND METHODS: the retrospective study included 69 patients (28 women and 41 men) treated during 2002–2012 in the Department of Otolaryngology and Laryngological Oncology of Poznań University of Medical Sciences. Of these patients, 47 were operated endoscopically, 16 received a double procedure and six received an external procedure. RESULTS: The recurrence rate in patients treated endoscopically was 32%, while patients treated by the external/double approach showed 64% (p = 0.03306). The recurrence rate after endoscopic surgery was 75% during 2002–2006, but was 28% during 2007–2012. There was no correlation between recurrence rate and age (p = 0.087686), gender (p = 0.42810), type of symptoms (p = 0.20955), or Krouse staging (p = 0.23658). A significant impact on relapses was the position to Ohngren’s plane (p = 0.004768) and tumor location in the anterior ethmoid (p = 0.00416). DISCUSSION: Endoscopic procedures are an effective method of IP treatment, however reasonable indications and surgeon experience should be taken into consideration.
4
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Learning curve for laparoscopic Roux-en-Y gastric bypass based on the experience of a newly created bariatric center

75%
Dworak J., Wysocki M., Rzepa A., Pędziwiatr M., Radkowiak D., Budzyński A., Major P.
Polish Journal of Surgery
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2020
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vol. 92(4)
23-30
EN
Introduction: Laparoscopic Roux-en-Y gastric bypass (LRYGB) is one of the most common treatments for morbid obesity. The learning curve for this procedure is 50–75 cases for an independent surgeon, and it is considered the most important factor in decreasing complications and mortality. We present our experience and learning curve with LRYGB for a newly established bariatric center in Poland. Material and methods: A prospectively collected database containing 285 LRYGB procedures performed in the II Department of General Surgery of the Jagiellonian University MC in Krakow between 06.2010 and 03.2019 was retrospectively reviewed. Patients were divided into groups of 30 (G1–G10) in the order of the procedures performed by each surgeon. The study analyzed the course of the operation and patient hospitalization, comparing those groups. Learning curve for the newly created bariatric center was established. Results: Operative time in G1–G3 differed significantly from G4–G10 (P < 0.0001). The stabilization point was the 90th procedure. Perioperative complications were observed in 36 (12.63%) patients. Perioperative complications, intraoperative difficulties and adverse events did not differ importantly among groups. Liberal use of “conversions of the operator” from a surgeon to a senior surgeon provides reasonable safety and prevents complications. Conclusions: The institutional learning process stabilization point for LRYGB in a newly established bariatric center is around the 90th operation. LRYGB can be a safe procedure from the very beginning in newly established bariatric centers. Specific bariatric training with active proctoring by an experienced surgeon in a bariatric centre can improve the laparoscopic gastric bypass outcome during the learning curve.
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