Laparoscopic adrenalectomy for beginners without open counterpart experience: initial results under staged training.
OBJECTIVE
To develop a staged laparoscopic training program for beginners to perform laparoscopic adrenalectomy (LA) and to determine its safety and feasibility.


METHODS
From January 2002 to October 2007, 5 beginners (postgraduate years 1-5) without previous experience in open adrenalectomy were selected randomly to receive the staged laparoscopic training, including box-trainer, animal model, and mentor-initiated clinical training. During the clinical training, the trainees acted as the camera holder first, and then selectively performed simple operations, such as laparoscopic renal cyst unroofing. Finally, they performed 30 LAs independently under the mentor's supervision using the technique of anatomic retroperitoneoscopic adrenalectomy. The clinical data of the 30 LAs performed by each the trainees (150 LAs total) were collected and compared with the data from the initial 30 LAs of the mentor.


RESULTS
All LAs were completed successfully. No procedure required conversion to open surgery. The median operative time of the trainees was 82.3 minutes (range 59-133), which was obviously shorten than the mentor's (median operative time 131.5 minutes, range 73-230, P < .001). The learning curve among the trainees was shorter compared with that of the mentor. No major complications were observed. The minor intraoperative and postoperative complication rate for the trainees was 0.67% and 6.7%, respectively, not significantly different from those of the mentor (0% and 3.3%, respectively; both P > .05). All complications developing in patients treated by the trainees required only conservative therapy.


CONCLUSIONS
It was safe and feasible for beginners without previous open counterpart experience to perform LA using staged training.
Zhang
Xu
X
Department of Urology, Clinical Division of Surgery, Chinese PLA General Hospital, Hai Dian District, Beijing, People's Republic of China. xzhang@tjh.tjmu.edu.cn
Wang
Baojun
B
Ma
Xin
X
Zhang
Guoxi
G
Shi
Taoping
T
Ju
Zhenghua
Z
Wang
Chao
C
Li
Hongzhao
H
Ai
Xing
X
Fu
Bin
B
D000315:Adrenalectomy / Q000379:methods*; D000818:Animals; D002983:Clinical Competence; D004195:Disease Models, Animal; D004502:Education, Medical, Continuing / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008505:Medical Staff, Hospital; D008611:Mentors; D019060:Minimally Invasive Surgical Procedures / Q000193:education*; D011336:Probability; D012680:Sensitivity and Specificity; D013552:Swine; D013556:Swine, Miniature; D014572:Urology / Q000193:education