Clinical outcomes and learning curve of a laparoscopic adrenalectomy in 103 consecutive cases at a single institute

Abstract

Objective : We examined the clinical outcomes and the learning curve for a laparoscopic adrenalectomy (LA) in 103 consecutive cases performed by three surgeons at our institute, according to the type of adrenal disorder. Patients and Methods : One hundred and three patients with adrenal tumors, including 38 cases of primary aldosteronism, 33 cases of Cushing syndrome (including preclinical Cushing syndrome), 15 cases of pheochromocytoma, and nine cases of nonfunctioning adenoma were evaluated, while focusing on the approaches, intraoperative and postoperative data, and the learning curve of LA, according the type of adrenal disorder. Results : There was no significant difference in the operation time, estimated blood loss, incidence of conversion to open surgery and blood transfusion, or postoperative recovery among the patients treated by LA for aldosteronoma, Cushing adenoma, pheochromocytoma, and non-functioning adenoma. In the cases of aldosteronoma and Cushing adenoma, the learning curve for the operation time and blood loss in each operator tended to decrease as the number of operations increased. On the other hand, in the cases treated by LA for pheochromocytoma, no trends in either the operation time or blood loss were observed. However, there has been neither any conversion to open surgery nor blood transfusion in cases treated by LA since 1998 (our 42nd case), even after the changes in the operators. Conclusions : Our results clearly indicate that LA is becoming safer than before, probably due to improvements in the technique, education, and training of surgeons, in addition to the increased number of cases now treated by LA.

Effect of virtual reality training on laparoscopic surgery: randomised controlled trial

“…It is evident, however, that laparoscopy is associated with a longer operation time and a higher rate of surgical complications during the learning curve of the surgeons. This has been verified in many different specalties, including general5 6 urological,7 8 paediatric,9 and gynaecological surgery 10. The possibility of overcoming these problems during the learning curve by appropriate training and ensuring that surgeons perform a sufficient number of procedures has also been documented 11.…”

Analysis of complications of laparoscopic management of abdominal diseases related to extended indications

“…This phenomenon is Table VI. Treatment of complications requiring surgical intervention often described in the literature [5,9,10,11,14,15]. More importantly, complication-driven conversions were reduced significantly, from 0.6% in the 1 st period to 0.27% and 0.26%.…”

“…Although they affect the method significantly, they happen so rarely that it is difficult to find any epidemiological pattern. Similarly to our material, the literature on laparoscopy shows increasing use of this technique in treatment of complications [4,10,19,24,29]. These of course are not biliary tree injuries, but haemorrhage, abscess and some selected digestive tract injuries can be effectively treated with laparoscopic technique and minimum risk to the patient.…”

“…In the next stage, the number of procedures performed laparoscopically increases significantly and the spectrum of indications broadens. Year after year, the rate of technically advanced procedures, such as Nissen fundoplication, cardiomyotomy, splenectomy and adrenalectomy, increases [8][9][10][11]. In spite of proven experience, the complexity of new procedures and freer qualification of patients prevent the total number of adverse events from falling substantially [8,10].…”

Complications with laparoscopically assisted gastrectomy: multivariate analysis of 300 consecutive cases

“…Several studies on the learning curve for laparoscopy used conversion rate, operation time, blood loss, major morbidity, and mortality as important parameters. Eto et al [19], in their study on laparoscopic adrenalectomy, reported that open conversion and transfusion were not needed after surgery in 42 cases. Kanno et al [20], in their research on laparoscopic nephrectomy, stated that the more experience a surgeon had, the less the complication rate and operation time increased, and the numbers showed a notable decrease after 50 cases.…”