The learning curve of laparoendoscopic single-site adrenalectomy: an analysis of over 100 cases

Fukumoto, Keishiro; Miyajima, Akira; Hattori, Seiya; Matsumoto, Kazuhiro; Abe, Takayuki; Kurihara, Isao; Jinzaki, Masahiro; Kikuchi, Eiji; Oya, Mototsugu

doi:10.1007/s00464-016-4950-6

Cited by 9 publications

(5 citation statements)

References 19 publications

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“…In many studies, SILS is suggested to be a safe surgical procedure and yield superior cosmetic effects than conventional laparoscopic surgery. However, although SILS is difficult to perform, little is known about its learning curve assessment and the factors associated with operative outcomes during the learning period [3].…”

Section: Discussionmentioning

confidence: 99%

“…around the umbilical single-site incision, which often results in instruments interfering with each other in a single port site, colloquially referred to as sword fighting. To prevent sword fighting, Fukomoto et al [3] suggested that one-handed maneuvers are performed in the early phase of laparoscopic adrenalectomy, and the crossover technique is then performed. With this technique, the instruments are crossed at the platform (SILS TM port).…”

Section: Single-site Incision Laparoscopic Surgery [Sils] Involves a ...mentioning

confidence: 99%

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Learning curve analysis of single-site incision laparoscopic adnexal surgery performed by a single surgeon

2022

Ginekol Pol

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Section: Discussionmentioning

confidence: 99%

Section: Single-site Incision Laparoscopic Surgery [Sils] Involves a ...mentioning

confidence: 99%

Learning curve analysis of single-site incision laparoscopic adnexal surgery performed by a single surgeon

2022

Ginekol Pol

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“…15 After an analysis of 103 LESS adrenalectomies, the learning curve using the cross handed technique finally stabilized after 30 cases. 16 Despite these advancements, the use of LESS techniques for adrenalectomy has decreased over the last decade. 17 The introduction of the da Vinci robotic system has allowed improved visualization and surgical maneuverability.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Perioperative Outcomes Between Single-Port and Multi-Port Robotic Adrenalectomy

Fang

Fazendin

Rais‐Bahrami

et al. 2022

The American Surgeon™

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Background Single-port (SP) robotic surgery has been utilized in several surgical procedures. We aim to describe our institution’s approach and perioperative experience with SP robotic adrenalectomy and compare it to the traditional multi-port (MP) approach. Methods We retrospectively reviewed all patients who underwent robotic adrenalectomy by a single surgeon between March 2019 and March 2020. Patient demographic, perioperative factors, and pathologic outcomes were recorded and analyzed using t-tests, chi-square, or Fisher’s exact tests. Results Thirty-six patients underwent SP (n = 11) and MP (n = 25) robotic adrenalectomy. Age, body mass index, gender, operative time, major Clavien-Dindo complications, and margin status showed no differences. Patients undergoing SP adrenalectomy had a lower estimated blood loss (18.1 ± 13.0 vs 65.6 ± 95.0 cc, P = .02) and smaller lesion size (2.8 ± 1.3 vs 4.1 ± 1.8 cm, P = .04) compared to those undergoing MP. Conclusions SP adrenalectomy appears to be a feasible approach in select adrenal masses. Further studies are needed to establish its safety and cost effectiveness.

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“…Hirsawa et al reported the differences in operative time between the first 12 operations and the operations that followed performed by the same surgeon, and mean operative time was reduced from 128 to 106 min after 12 cases. Fukumoto et al [ 52 ] demonstrated that surgeons acquired master-level expertise after 30 operations and performed the operation at a significantly shorter operative time. The disparities in the sample size of the included LESS-A studies were tremendous, ranging from 9 to 70 patients.…”

Section: Discussionmentioning

confidence: 99%

Laparoendoscopic single-site adrenalectomy versus multi-port laparoendoscopic adrenalectomy: A systemic review and meta-analysis

Kang

et al. 2021

Annals of Medicine &Amp; Surgery

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Background To investigate the outcomes of laparoendoscopic single-site adrenalectomy (LESS-A) compared to multi-port laparoendoscopic adrenalectomy (m-LA). Methods Studies comparing LESS-A with m-LA were identified from PubMed, Embase, and Cochrane Library before June 2020. Post-operative pain, resumption outcomes, and perioperative outcomes were analyzed. We conducted meta-analyses using the Mantel-Haenszel method with random-effects model. Subset analyses were conducted according to peritoneal and retroperitoneal approaches. A small study effect was illustrated using funnel plots and Egger's test. Results One randomized controlled trial (RCT) and nineteen retrospective cohort studies involving 1554 patients were included for analyzed. Pooled analysis showed that LESS-A had significantly lower postoperative pain scores (MD −0.77, 95%CI −1.45 to −0.10) and less pain medication used (RR 0.74, 95%CI 0.60 to 0.91) compared to m-LA. Besides, LESS-A had significantly shorter hospital stays (MD −0.75, 95%CI −1.18 to −0.33), shorter duration of oral intake resumption (MD −0.33, 95%CI −0.60 to −0.06), and better cosmetic satisfaction (SMD 1.15, 95%CI 0.21 to −2.09). As for perioperative outcomes, LESS-A led to significant longer operative time (MD 13.43, 95%CI 4.08 to 22.77). No significant differences were observed in terms of the remaining perioperative outcomes. Conclusions LESS-A is associated with less post-operative pain and quicker recovery duration. However, the longer operative time of LESS-A compared with m-LA is a drawback.

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The learning curve of laparoendoscopic single-site adrenalectomy: an analysis of over 100 cases

Abstract: LESS-A was performed safely in most cases. However, surgeons who are learning the LESS-A procedure need to pay attention to tumor size and visceral obesity.

Cited by 9 publications

References 19 publications

Learning curve analysis of single-site incision laparoscopic adnexal surgery performed by a single surgeon

Learning curve analysis of single-site incision laparoscopic adnexal surgery performed by a single surgeon

Comparison of Perioperative Outcomes Between Single-Port and Multi-Port Robotic Adrenalectomy

Laparoendoscopic single-site adrenalectomy versus multi-port laparoendoscopic adrenalectomy: A systemic review and meta-analysis

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