Abstract
Background
Soon after its introduction, laparoscopic adrenalectomy (LA) became the procedure of choice in the surgical management of most adrenal tumors. The aim of this study was to assess the outcome and learning curve of the first 100 cases operated by the same surgical team.
Methods
Retrospective analysis of prospectively collected data of 100 consecutive LAs was performed. The parameters studied were indication for surgery, side and length of operation, intra- and postoperative complications, size of tumor, conversion to open surgery, final diagnosis, and length of stay.
Results
Between 1996 and 2002, 100 LAs were performed in 90 patients. The procedures included 45 left, 35 right, and 10 bilateral resections for pheochromocytoma (29), Cushing’s syndrome (27), Conn’s syndrome (16), nonfunctioning adenoma (13), and others (5). Mean tumor size was 4.16 cm (range, 0.3–11). Overall major morbidity occurred in eight patients (9%); there was one mortality due to cerebrovascular accident in an elderly patient. Five cases (5%) were converted to open surgery. The mean length of stay for the whole group was 4.7 days (range, 2–25). In order to assess the learning curve, procedures were divided into three, equal consecutive groups (n = 33, 33, and 34). Intraoperative complications in the intermediate and late groups were significantly less compared to those in the early group (2/33, 2/34, and 7/33, respectively; (p < 0.05). Similarly, the mean operating time was significantly reduced between the early (169 min) and both intermediate (116 min) and late (127 min) groups (p < 0.005). The conversion rate was reduced between the three groups (3/33, 2/33, and 0/34), but this was not significant (p = 0.06).
Conclusions
As expected, the outcome of LA is associated with a steep learning curve. According to this study, it seems that performance of approximately 30 cases by an experienced laparoscopic surgeon is required to master the procedure.
Similar content being viewed by others
References
M Barreca Presentil C Renzi G Cavallavo Borrellia FV AStipa (2003) ArticleTitleExpectations and outcomes when moving from open to laparoscopic adrenalectomy: multivariate analysis. World J Surg 27 223–228 Occurrence Handle12616441
MM Desai IS Gill JH Kauk SF Matin GT Surg EL Bravo (2002) ArticleTitleRobotic assisted laparoscopic adrenalectomy. Urology 60 1104–1107 Occurrence Handle12475680
M Gagner (1991) ArticleTitleLaparoscopic adrenalectomy. Surg Clin North Am 76 523–537
D Hazzan E Shiloni O Jurim D Gross P Reissman (2001) ArticleTitleLaparoscopic versus open adrenalectomy for benign adrenal neoplasms. Surg Endosc 15 1356–1358 Occurrence Handle1:STN:280:DC%2BD3MnotV2kuw%3D%3D Occurrence Handle11727150
IG La QY Duh (2003) ArticleTitleLaparoscopic adrenalectomy—indications and techniques. Surg Oncol 12 105–123 Occurrence Handle12946482
AM Lacy JC Garicia-Valdecasas S Delgado A Castells J Viga (2002) ArticleTitleLaparoscopic-assisted colectomy versus open colectomy for treatment of nonmetastatic colon cancer: a randomised trial. Lancet 359 2224–2229 Occurrence Handle12103285
DWH Lee SCS Chung (1995) ArticleTitleLaparoscopic adrenalectomy. Int Surg 80 311–314 Occurrence Handle1:STN:280:BymA3cbhs10%3D Occurrence Handle8740675
DL Maccabee A Jones J Domreis CW Deveney BC Sheppard (2003) ArticleTitleTransition from open to laparoscopic adrenalectomy. Surg Endosc . .
J Rassweiler A Tsivian AV Kumar C Lymberakis M Schulze O Seen T Frede (2003) ArticleTitleOncological safety of laparoscopic surgery for urological malignancy: experience with more than 1,000 operations. J Urol 169 2072–2075 Occurrence Handle12771722
P Reissman S Chen EG Weiss SD Wexner (1996) ArticleTitleLaparoscopic colorectal surgery: ascending the learning curve. World J Surg 20 277–282 Occurrence Handle10.1007/s002689900044 Occurrence Handle1:STN:280:BymA38rmt1A%3D Occurrence Handle8661831
SJ Shichman (1999) ArticleTitleLateral transperitoneal laparoscopic adrenalectomy. World J Urol 17 48–53 Occurrence Handle1:STN:280:DyaK1M7psFyrtw%3D%3D Occurrence Handle10096151
O Zmora P Gervaz SD Wexner (2001) ArticleTitleTrocar site recurrence in laparoscopic surgery for colorectal cancer: myth or concern. Surg Endosc 15 788–793 Occurrence Handle1:STN:280:DC%2BD3MrksFSjtw%3D%3D Occurrence Handle11443452
Author information
Authors and Affiliations
Corresponding author
Additional information
An erratum to this article can be found at http://dx.doi.org/10.1007/s00464-004-0086-1.
Rights and permissions
About this article
Cite this article
David, G., Yoav, M., Gross, D. et al. Laparoscopic adrenalectomy. Surg Endosc 18, 771–773 (2004). https://doi.org/10.1007/s00464-003-8830-5
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00464-003-8830-5