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


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 non-functioning 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.
Eto
Masatoshi
M
Department of Urology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan. etom@uro.med.kyushu-u.ac.jp
Harano
Masahiko
M
Koga
Hirofumi
H
Tanaka
Masatoshi
M
Naito
Seiji
S
D000310:Adrenal Gland Neoplasms / Q000628:therapy*; D000315:Adrenalectomy / Q000193:education* / Q000379:methods; D004502:Education, Medical, Continuing; D006282:Health Personnel; D006801:Humans; D007564:Japan; D010535:Laparoscopy / Q000379:methods; D008505:Medical Staff, Hospital / Q000193:education*; D012189:Retrospective Studies; D016896:Treatment Outcome