Laparoscopic Adrenalectomy - Assessing the Learning Curve

• Authors: Patryk Fiszer , Sadegh Toutounchi , Ryszard Pogorzelski , Ewa Krajewska , Witold Cieśla , Maciej Skórski
• Languages of publication: EN

Abstracts

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.

Keywords

EN

laparoscopic adrenalectomy; learning curve; adrenal tumor

• Publisher: De Gruyter Open
• Journal: Polish Journal of Surgery
• Year: 2012
• Volume: 84
• Issue: 6
• Pages: 293-297

Dates

published

1 - 6 - 2012

online

28 - 7 - 2012

Contributors

author

Patryk Fiszer

• Department of General and Thoracic Surgery, Warsaw Medical University

author

Sadegh Toutounchi

• Department of General and Thoracic Surgery, Warsaw Medical University

author

Ryszard Pogorzelski

• Department of General and Thoracic Surgery, Warsaw Medical University

author

Ewa Krajewska

• Department of General and Thoracic Surgery, Warsaw Medical University

author

Witold Cieśla

• Department of General and Thoracic Surgery, Warsaw Medical University

author

Maciej Skórski

• Department of General and Thoracic Surgery, Warsaw Medical University

References

• Gupta PK, Natarajan B, Pallati PK et al.: Outcomes after laparoscopic adrenalectomy. Surg Endosc 2011; 25(3): 784-94.[PubMed][Crossref]
• Hallfeldt KK, Mussack T, Trupka A et al.: Laparoscopic lateral adrenalectomy versus open posterior adrenalectomy for the treatment of benign adrenal tumors. Surg Endosc 2003; 17(2): 264-67.[Crossref][PubMed]
• Thompson GB, Grant CS, van Heerden JA et al.: Laparoscopic versus open posterior adrenalectomy: a case-control study of 100 patients. Surgery 1997; 122(6): 1132-36.[Crossref][PubMed]
• Gaujoux S, Bonnet S, Leconte M et al.: Risk factors for conversion and complications after unilateral laparoscopic adrenalectomy. Br J Surg 2011; 98(10): 1392-99.
• Castillo OA, Vitagliano G, Secin FP et al.: Laparoscopic adrenalectomy for adrenal masses: does size matter? Urology 2008; 71(6): 1138-41.[PubMed][Crossref]
• Brix D, Allolio B, Fenske W et al.: Laparoscopic versus open adrenalectomy for adrenocortical carcinoma: surgical and oncologic outcome in 152 patients. Eur Urol 2010; 58(4): 609-15.[Crossref]
• Tessier DJ, Iglesias R, Chapman WC et al.: Previously unreported high-grade complications of adrenalectomy. Surg Endosc 2009; 23(1): 97-102.[PubMed][Crossref][WoS]
• Lin YY, Shabbir A, So JB: Laparoscopic appendectomy by residents: evaluating outcomes and learning curve. Surg Endosc 2010; 24(1): 125-30.[Crossref][PubMed]
• Kayano H, Okuda J, Tanaka K et al.: Evaluation of the learning curve in laparoscopic low anterior resection for rectal cancer. Surg Endosc 2011; 25(9): 2972-79.[PubMed][Crossref]
• Guerrieri M, Campagnacci R, De Sanctis A et al.: The learning curve in laparoscopic adrenalectomy. J Endocrinol Invest 2008; 31(6): 531-36.[PubMed]
• Murphy MM, Witkowski ER, Ng SC et al.: Trends in adrenalectomy: a recent national review. Surg Endosc 2010; 24(10): 2518-26.[Crossref][WoS][PubMed]

Identifiers

DOI

10.2478/v10035-012-0049-5