title: Evaluating the learning curve for retroperitoneoscopic adrenalectomy in a high-volume center for laparoscopic adrenal surgery.
abstract: Laparoscopic adrenalectomy is an effective method for benign adrenal tumor removal. In the literature, both lateral transperitoneal (TLA) and posterior retroperitoneoscopic (RPA) approaches are described. Since 2007, the number of patients increased significantly in our center. Therefore, RPA was introduced in 2011 because of its potential advantages in operating and recovery times. The learning curve of RPA is now evaluated.
  
  
  
  All data of patients undergoing laparoscopic adrenalectomy from 2007 until 2014 were prospectively collected. Patients were eligible for RPA with a tumor <7 cm, with BMI < 35 kg/m2, and with low suspicion of malignancy. The learning curve of RPA was measured by operating time. Furthermore, blood loss, preoperative complications and hospital stay were analyzed. Descriptive statistics were performed using SPSS 20.0.
  
  
  
  In the study period, 290 patients underwent surgery, of whom 113 underwent RPA. After starting with RPA, operating times decreased significantly (median 100 min in the first 20 patients to 60 min after 40 patients, p < 0.05). There was a significant difference in operating times (median 108 vs. 62 min, p < 0.05) and hospital stay (median 4 vs. 3 days, p < 0.05) in unilateral surgery in favor of RPA, compared to TLA. Also in bilateral surgery, operating times were significantly shorter (median 236 vs. 117 min, p < 0.05). In both groups, few major complications occurred.
  
  
  
  After the introduction of RPA, a short learning curve was seen for a single surgeon with extensive experience in laparoscopic adrenal surgery. Compared to TLA, RPA has significant advantages in operating times and hospital stay. Therefore, RPA may be the preferred approach for patients with BMI < 35 kg/m2and small benign adrenal tumors (<7 cm).
authors.affiliation: Department of Urology, Radboud University Medical Centre, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands. allonvanuitert@gmail.com.
authors.forename: A
authors.identifier: 0000-0002-0923-2401
authors.initials: A
authors.lastname: van Uitert
authors.affiliation: Department of Urology, Radboud University Medical Centre, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands.
authors.forename: F C H
authors.initials: FCH
authors.lastname: d'Ancona
authors.affiliation: Department of Internal Medicine, Radboud University Medical Centre, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands.
authors.forename: J
authors.initials: J
authors.lastname: Deinum
authors.affiliation: Department of Internal Medicine, Radboud University Medical Centre, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands.
authors.forename: H J L M
authors.initials: HJLM
authors.lastname: Timmers
authors.affiliation: Department of Urology, Radboud University Medical Centre, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands.
authors.forename: J F
authors.initials: JF
authors.lastname: Langenhuijsen
mesh_terms: D000307:Adrenal Gland Diseases / Q000601:surgery*; D000315:Adrenalectomy / Q000379:methods* / Q000523:psychology; D000328:Adult; D000368:Aged; D002983:Clinical Competence; D005260:Female; D061847:Hospitals, High-Volume; D006801:Humans; D010535:Laparoscopy / Q000379:methods* / Q000523:psychology; D059032:Learning Curve; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D011446:Prospective Studies; D012187:Retroperitoneal Space / Q000601:surgery*; D016896:Treatment Outcome
keywords: Adrenal surgery; Benign adrenal disease; Laparoscopic surgery; Retroperitoneoscopic surgery