Goitein D, Mintz Y, Gross D, Reissman P
Department of surgery, Hadassah University Hospital, 91031 Jerusalem, Israel.
Surg Endosc. 2004 May;18(5):771-3. doi: 10.1007/s00464-003-8830-5. Epub 2004 Apr 6.
Soon after its introduction, laparoscopic adrenalectomy (LA) became the procedure of choice in the surgical management of most adrenal tumors. The aim of this study was to assess the outcome and learning curve of the first 100 cases operated by the same surgical team.
Retrospective analysis of prospectively collected data of 100 consecutive LAs was performed. The parameters studied were indication for surgery, side and length of operation, intra- and postoperative complications, size of tumor, conversion to open surgery, final diagnosis, and length of stay.
Between 1996 and 2002, 100 LAs were performed in 90 patients. The procedures included 45 left, 35 right, and 10 bilateral resections for pheochromocytoma (29), Cushings syndrome (27), Conns syndrome (16), nonfunctioning adenoma (13), and others (5). Mean tumor size was 4.16 cm (range, 0.3-11). Overall major morbidity occurred in eight patients (9%); there was one mortality due to cerebrovascular accident in an elderly patient. Five cases (5%) were converted to open surgery. The mean length of stay for the whole group was 4.7 days (range, 2-25). In order to assess the learning curve, procedures were divided into three, equal consecutive groups (n = 33, 33, and 34). Intraoperative complications in the intermediate and late groups were significantly less compared to those in the early group (2/33, 2/34, and 7/33, respectively; (p < 0.05). Similarly, the mean operating time was significantly reduced between the early (169 min) and both intermediate (116 min) and late (127 min) groups (p < 0.005). The conversion rate was reduced between the three groups (3/33, 2/33, and 0/34), but this was not significant (p = 0.06).
As expected, the outcome of LA is associated with a steep learning curve. According to this study, it seems that performance of approximately 30 cases by an experienced laparoscopic surgeon is required to master the procedure.
腹腔镜肾上腺切除术（LA）应用后不久，便成为大多数肾上腺肿瘤外科治疗的首选术式。本研究旨在评估同一手术团队实施的前100例手术的结果及学习曲线。
对前瞻性收集的100例连续LA手术数据进行回顾性分析。研究参数包括手术指征、手术侧别及时长、术中及术后并发症、肿瘤大小、转为开放手术情况、最终诊断及住院时长。
1996年至2002年期间，90例患者接受了100例LA手术。手术包括45例左侧、35例右侧及10例双侧切除术，涉及嗜铬细胞瘤（29例）、库欣综合征（27例）、原发性醛固酮增多症（16例）、无功能腺瘤（13例）及其他（5例）。肿瘤平均大小为4.16 cm（范围0.3 - 11 cm）。8例患者（9%）发生总体严重并发症；1例老年患者因脑血管意外死亡。5例（5%）转为开放手术。全组平均住院时长为4.7天（范围2 - 25天）。为评估学习曲线，将手术分为连续的三组，每组数量相等（n = 33、33和34）。中期和后期组的术中并发症明显少于早期组（分别为2/33、2/34和7/33；p < 0.05）。同样，早期组（169分钟）与中期（116分钟）和后期（127分钟）组相比，平均手术时间显著缩短（p < 0.005）。三组间的转化率降低（3/33、2/33和0/34），但差异无统计学意义（p = 0.06）。
正如预期，LA的结果与陡峭的学习曲线相关。根据本研究，经验丰富的腹腔镜外科医生似乎需要完成约30例手术才能掌握该术式。
