%0 Journal Article
%T Transperitoneal Laparoscopic Adrenalectomy: Assessment of the Surgical Learning Curve
%A Lukas Meier
%A Henryk Zulewski
%A Daniel Oertli
%J ISRN Minimally Invasive Surgery
%D 2013
%R 10.1155/2013/936209
%X Background. We report a single surgeon¡¯s experience of 52 transperitoneal laparoscopic adrenalectomies (LAs) performed between 2001 and 2010. In addition, we compared this series with our first published series of LAs performed between 1994 and 2001. Methods. Our series includes 24 left, 20 right, and 4 bilateral LAs performed in 48 patients. To estimate the learning curve, we chronologically divided the sample of unilateral LAs into two groups of 22 patients and compared the operating time, estimated blood loss, maximum diameter of the lesion, complications, and length of hospital stay. Results. Mean operating time was significantly lower (94 versus 78£¿min, ) and mean intraoperative blood loss was significantly lower (156 versus 60£¿mL, ) after more experience had been gained. Additionally, a trend towards removing larger lesions was observed. There was no significant difference in terms of hospital stay. Conclusions. Observing a single surgeon¡¯s experience of nine years in laparoscopic adrenalectomy, this study indicates that it takes approximately 20¨C25 procedures to flatten the learning curve. Thus, for single centers with a volume of approximately five LAs performed per year, we suggest a selection of a few experienced surgeons to perform LAs in order to improve outcomes. 1. Background Since its first performance in 1992, laparoscopic adrenalectomy (LA) has quickly become the standard method for surgical treatment of benign and selected malignant adrenal pathologies [1, 2]. Although there are no randomized controlled studies comparing open adrenalectomy versus LA, the multitude of retrospective analyses and case reports clearly demonstrate the benefits of LA in terms of feasibility, safety, morbidity, hospital stay, and recovery time [2¨C7]. We have already affirmed the benefits of LA with our first series of 22 LAs performed between 1994 and 2001. Compared with open adrenalectomy, LA resulted in less blood loss, lower postoperative analgesic requirements, and shorter hospital stays [8]. The aim of this paper is to present our subsequent series of 52 consecutive transperitoneal LAs performed between 2001 and 2010 in order to evaluate the learning curve associated with this technique. We reevaluated the major parameters (indications, morbidity, hospital stay, blood loss, and lesion size) and especially focused on operative duration over time. 2. Methods For this survey, we retrospectively included all patients in whom unilateral or bilateral transperitoneal LA was performed between April 2001 and November 2010. The most common indication was a
%U http://www.hindawi.com/journals/isrn.mis/2013/936209/