title: Laparoscopic adrenalectomy--assessing the learning curve.
abstract: Laparoscopic adrenalectomy (LA) has become the "gold standard" for treatment of most of adrenal tumors in last few years. It has many benefits comparing to open surgery, but still is considered as complicated procedure requiring experienced surgical team.
  
  
  OBJECTIVE
  was to assess the learning curve of laparoscopic adrenalectomy and the outcome of the first consecutive 154 LA.
  
  
  METHODS
  154 consecutive patients undergoing LA between 2007 and 2010 were reviewed. Collected data included: patients demographics, clinical and histological diagnosis, side and length of operation, conversions to open surgery, complications and hospitalization time. Learning curve was evaluated by dividing all patients into three groups (group I - first 50 patients, group II - second 50 patients and group III last 54 patients). Differences between the groups were analyzed.
  
  
  RESULTS
  There were 154 LAs performed. Indications for LA were hormonally inactive adrenal adenoma(n=57), Conn's syndrome (n=30), Cushing's syndrome (n=28), pheochromocytoma (n=27), adrenal cyst (n=8), and others (n=4). Mean tumor size was 45.28 mm. There were 79 left-sided and 75 right-sided procedures and the average time of hospitalization was 4.64 days. Mean operative time was statistically different between the groups (216.2 min. - 164.6 min. - 131.9 min.; p<0.01) as well as the number of conversions to open surgery (18% - 4% - 3.7%; p=0.013). There was not any significant difference in the number of complications between analyzed groups (2% - 2% -3.7%).
  
  
  CONCLUSIONS
  To improve the outcome of LA it is necessary to perform approximately 40 to 50 procedures.
authors: Department of General and Thoracic Surgery, Warsaw Medical University, Poland.
authors: Patryk
authors: P
authors: Fiszer
authors: Sadegh
authors: S
authors: Toutounchi
authors: Ryszard
authors: R
authors: Pogorzelski
authors: Ewa
authors: E
authors: Krajewska
authors: Witold
authors: W
authors: Cieśla
authors: Maciej
authors: M
authors: Skórski
mesh_terms: D000236:Adenoma / Q000601:surgery; D000307:Adrenal Gland Diseases / Q000453:epidemiology / Q000601:surgery*; D000310:Adrenal Gland Neoplasms / Q000453:epidemiology / Q000601:surgery; D000315:Adrenalectomy / Q000379:methods / Q000706:statistics & numerical data*; D000328:Adult; D000368:Aged; D003480:Cushing Syndrome / Q000453:epidemiology / Q000601:surgery; D005260:Female; D006801:Humans; D006929:Hyperaldosteronism / Q000453:epidemiology / Q000601:surgery; D010535:Laparoscopy / Q000379:methods / Q000706:statistics & numerical data*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010673:Pheochromocytoma / Q000453:epidemiology / Q000601:surgery; D011044:Poland / Q000453:epidemiology; D016896:Treatment Outcome