Volume-outcome correlation in adrenal surgery—an ESES consensus statement

Abstract

Background Published data in the last decade showed that a majority of adrenal operations are done by surgeons performing only one such case per year and based on the distribution of personal workloads 'high-volume' surgeons are defined as those doing 4 or more cases/year. Purpose This paper summarises literature data identified by a working group established by the European Society of Endocrine Surgeons (ESES). The findings were discussed during ESES-2019 conference and members agreed on a consensus statement. Results The annual of adrenal operations performed yearly in individual countries was reported to be 800/year in UK and over 1600/year in France. The learning curve of an individual surgeon undertaking laparoscopic, retroperitoneoscopic or robotic adrenalectomy is estimated to be 20-40 cases. Preoperative morbidity and length of stay are more favourable in high-volume centres. Conclusion The main recommendations are that adrenal surgery should continue only in centres performing at least 6 cases per year, surgery for adrenocortical cancer should be restricted to centres performing at least 12 adrenal operations per year, and an integrated multidisciplinary team should be established in all such centres. Clinical information regarding adrenalectomies should be recorded prospectively and contribution to the established EUROCRINE and ENSAT databases is strongly encouraged. Surgeons wishing to develop expertise in this field should seek mentorship and further training from established adrenal surgeons.

Robotic Versus Laparoscopic Adrenalectomy: Pluriannual Experience in a High-Volume Center Evaluating Indications and Results

“… 5 , 23 , 25 The shorter hospital stay may allow also reducing costs of hospitalization and a higher turnover of patients in surgical units, thus balancing the principal drawback of robotic platform of higher costs. 6 , 8 , 26 Brunaud et al calculated that robotic approach was 2.3 times more expensive than laparoscopic one, 6 but notably, costs could be curtailed by increasing the annual workload of robotic surgical procedures in high-volume centers, 4 , 26 leading also to a facilitation of the learning curve. From this cost-saving standpoint, the widespread adoption of robotic technology may conduct to a beneficial effect on robotic purchase, but published data at present are not sufficient yet and further studies are necessary.…”

“…From this cost-saving standpoint, the widespread adoption of robotic technology may conduct to a beneficial effect on robotic purchase, but published data at present are not sufficient yet and further studies are necessary. 26 , 27 …”

“…5,23,25 The shorter hospital stay may allow also reducing costs of hospitalization and a higher turnover of patients in surgical units, thus balancing the principal drawback of robotic platform of higher costs. 6,8,26 Data presented were n (%), unless specified. BMI, body mass index (kg/m 2 ); LA-g, laparoscopic adrenalectomy group; RA-g, robotic adrenalectomy group.…”

Comparative performances of nomograms and conditional survival after resection of adrenocortical cancer

“…The small sample size limits statistical power and inferences as well as precluding meaningful subgroup analyses. Based on recent evidence for volume–outcome correlation in adrenal surgery, the European Society of Endocrine Surgeons 30 has recommended that the care of ACC should continue in centres performing at least 12 adrenal operations per year. As this is an observational study, there was some selection bias.…”

SimLife model: introducing a new teaching device in endocrine surgery simulation

“…Two surveys conducted by the American Association of Endocrine Surgeons (AAES) reported that surgical residents performed 2 neck dissection procedures prior to their graduation, while clinical fellows in endocrine surgery performed 6–15 procedures during their 2-year fellowship program with 12 procedures being the cut-off number of procedures required to obtain competency [ 3 , 4 ]. Mihai et al recently analyzed the current practice in adrenal surgery worldwide [ 5 ]. The results reported were far from being encouraging.…”