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Surgical Endoscopy
Published in: Surgical Endoscopy 10/2014

01-10-2014

Laparoendoscopic single-site adrenalectomy versus conventional laparoscopic adrenalectomy: a comparison of surgical outcomes and an analysis of a single surgeon’s learning curve

Authors: Yosuke Hirasawa, Akira Miyajima, Seiya Hattori, Kazutoshi Miyashita, Isao Kurihara, Hirotaka Shibata, Eiji Kikuchi, Ken Nakagawa, Mototsugu Oya

Published in: Surgical Endoscopy | Issue 10/2014

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Abstract

Background

Conventional laparoscopic adrenalectomy (LA) is the gold standard procedure for benign adrenal tumors. Laparoendoscopic single-site adrenalectomy (LESS-A) has been developed as an extension of standard laparoscopic minimally invasive procedures.

Methods

This retrospective study compared the first experience of one surgeon with 70 LESS-A to 140 LA cases with respect to evaluating the influence of the inexperience on surgical outcomes and to assess this surgeon’s learning curve for LESS-A.

Results

Age, gender, BMI, percentage of patients with prior abdominal surgery, tumor laterality, and tumor size were all comparable between the two groups. There were no statistically significant differences in any surgical outcomes, including mean operative time, pneumoperitoneum time, estimated blood loss, transfusion requirements, hemoglobin decrease at postoperative day 1, analgesic requirements, postoperative day of oral intake, conversion rate, or morbidity between the two groups. The one exception was hospital stay. There were no mortalities or reoperations in either group. The morbidity rates in the LESS-A group and LA group were 4.2 and 6.4 %, respectively (p = 0.528). LESS-A appears to have a steep learning curve and the operative time of the initial 70 cases decreased markedly and remained stable when the experience level exceeded 12 cases. There was no morbidity or conversion in these first 12 LESS-A cases. Multiple regression analysis revealed that surgeon experience (p = 0.008) and tumor size (p = 0.001) were independent predictors of prolonged operative time.

Conclusions

Surgical outcomes of LESS-A were equivalent to those of LA without compromising safety. The introduction of LESS-A at our hospital was smooth and safe. While the indication for LESS-A has been controversial, LESS-A was a useful procedure, especially for cases in which cosmesis is of paramount importance.
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Metadata
Title
Laparoendoscopic single-site adrenalectomy versus conventional laparoscopic adrenalectomy: a comparison of surgical outcomes and an analysis of a single surgeon’s learning curve
Authors
Yosuke Hirasawa
Akira Miyajima
Seiya Hattori
Kazutoshi Miyashita
Isao Kurihara
Hirotaka Shibata
Eiji Kikuchi
Ken Nakagawa
Mototsugu Oya
Publication date
01-10-2014
Publisher
Springer US
Published in
Surgical Endoscopy / Issue 10/2014
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-014-3553-3

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