Multicentre study evaluating the surgical learning curve for posterior retroperitoneoscopic adrenalectomy

O M Vrielink; A F Engelsman; P H J Hemmer; J de Vries; W M C M Vorselaars; M R Vriens; A Karakatsanis; P Hellman; M S Sywak; B L van Leeuwen; M El Moumni; S Kruijff

doi:10.1002/bjs.10740

Multicentre study evaluating the surgical learning curve for posterior retroperitoneoscopic adrenalectomy

O M Vrielink, A F Engelsman, P H J Hemmer, J de Vries, W M C M Vorselaars, M R Vriens, A Karakatsanis, P Hellman, M S Sywak, B L van Leeuwen, M El Moumni, S Kruijff

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

BACKGROUND: Posterior retroperitoneoscopic adrenalectomy has gained international popularity in the past decade. Despite major advantages, including shorter duration of operation, minimal blood loss and decreased postoperative pain, many surgeons still prefer laparoscopic transperitoneal adrenalectomy. It is likely that the unfamiliar anatomical environment, smaller working space and long learning curve impede implementation. The present study assessed the number of procedures required to fulfil the surgical learning curve for posterior retroperitoneoscopic adrenalectomy.

METHODS: The first consecutive posterior retroperitoneoscopic adrenalectomies performed by four surgical teams from university centres in three different countries were analysed. The primary outcome measure was duration of operation. Secondary outcomes were conversion to an open or laparoscopic transperitoneal approach, complications and recovery time. The learning curve cumulative sum (LC-CUSUM) was used to assess the learning curves for each surgical team.

RESULTS: A total of 181 surgical procedures performed by four surgical teams were analysed. The median age of the patients was 57 (range 15-84) years and 61·3 per cent were female. Median tumour size was 25 (range 4-85) mm. There were no significant differences in patient characteristics and tumour size between the teams. The median duration of operation was 89 (range 29-265) min. There were 35 perioperative and postoperative complications among the 181 patients (18·8 per cent); 17 of 27 postoperative complications were grade 1. A total of nine conversions to open procedures (5·0 per cent) were observed. The LC-CUSUM analysis showed that competency was achieved after a range of 24-42 procedures.

CONCLUSION: In specialized endocrine surgical centres between 24 and 42 procedures are required to fulfil the entire surgical learning curve for the posterior retroperitoneoscopic adrenalectomy.

Original language	English
Pages (from-to)	544-551
Number of pages	8
Journal	British Journal of Surgery
Volume	105
Issue number	5
DOIs	https://doi.org/10.1002/bjs.10740
Publication status	Published - Apr 2018

Keywords

Adrenal Gland Neoplasms/surgery
Adrenalectomy/education
Adult
Aged
Aged, 80 and over
Female
Humans
Laparoscopy/education
Learning Curve
Male
Middle Aged
New South Wales
Operative Time
Retroperitoneal Space
Young Adult

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10.1002/bjs.10740

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Vrielink, O. M., Engelsman, A. F., Hemmer, P. H. J., de Vries, J., Vorselaars, W. M. C. M., Vriens, M. R., Karakatsanis, A., Hellman, P., Sywak, M. S., van Leeuwen, B. L., El Moumni, M., & Kruijff, S. (2018). Multicentre study evaluating the surgical learning curve for posterior retroperitoneoscopic adrenalectomy. British Journal of Surgery, 105(5), 544-551. https://doi.org/10.1002/bjs.10740

@article{442516f75ba5495782786da2d68b3070,

title = "Multicentre study evaluating the surgical learning curve for posterior retroperitoneoscopic adrenalectomy",

abstract = "BACKGROUND: Posterior retroperitoneoscopic adrenalectomy has gained international popularity in the past decade. Despite major advantages, including shorter duration of operation, minimal blood loss and decreased postoperative pain, many surgeons still prefer laparoscopic transperitoneal adrenalectomy. It is likely that the unfamiliar anatomical environment, smaller working space and long learning curve impede implementation. The present study assessed the number of procedures required to fulfil the surgical learning curve for posterior retroperitoneoscopic adrenalectomy.METHODS: The first consecutive posterior retroperitoneoscopic adrenalectomies performed by four surgical teams from university centres in three different countries were analysed. The primary outcome measure was duration of operation. Secondary outcomes were conversion to an open or laparoscopic transperitoneal approach, complications and recovery time. The learning curve cumulative sum (LC-CUSUM) was used to assess the learning curves for each surgical team.RESULTS: A total of 181 surgical procedures performed by four surgical teams were analysed. The median age of the patients was 57 (range 15-84) years and 61·3 per cent were female. Median tumour size was 25 (range 4-85) mm. There were no significant differences in patient characteristics and tumour size between the teams. The median duration of operation was 89 (range 29-265) min. There were 35 perioperative and postoperative complications among the 181 patients (18·8 per cent); 17 of 27 postoperative complications were grade 1. A total of nine conversions to open procedures (5·0 per cent) were observed. The LC-CUSUM analysis showed that competency was achieved after a range of 24-42 procedures.CONCLUSION: In specialized endocrine surgical centres between 24 and 42 procedures are required to fulfil the entire surgical learning curve for the posterior retroperitoneoscopic adrenalectomy.",

keywords = "Adrenal Gland Neoplasms/surgery, Adrenalectomy/education, Adult, Aged, Aged, 80 and over, Female, Humans, Laparoscopy/education, Learning Curve, Male, Middle Aged, New South Wales, Operative Time, Retroperitoneal Space, Young Adult",

author = "Vrielink, {O M} and Engelsman, {A F} and Hemmer, {P H J} and {de Vries}, J and Vorselaars, {W M C M} and Vriens, {M R} and A Karakatsanis and P Hellman and Sywak, {M S} and {van Leeuwen}, {B L} and {El Moumni}, M and S Kruijff",

note = "Publisher Copyright: {\textcopyright} 2018 BJS Society Ltd Published by John Wiley & Sons Ltd",

year = "2018",

month = apr,

doi = "10.1002/bjs.10740",

language = "English",

volume = "105",

pages = "544--551",

journal = "British Journal of Surgery",

issn = "0007-1323",

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number = "5",

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Vrielink, OM, Engelsman, AF, Hemmer, PHJ, de Vries, J, Vorselaars, WMCM, Vriens, MR, Karakatsanis, A, Hellman, P, Sywak, MS, van Leeuwen, BL, El Moumni, M & Kruijff, S 2018, 'Multicentre study evaluating the surgical learning curve for posterior retroperitoneoscopic adrenalectomy', British Journal of Surgery, vol. 105, no. 5, pp. 544-551. https://doi.org/10.1002/bjs.10740

TY - JOUR

T1 - Multicentre study evaluating the surgical learning curve for posterior retroperitoneoscopic adrenalectomy

AU - Vrielink, O M

AU - Engelsman, A F

AU - Hemmer, P H J

AU - de Vries, J

AU - Vorselaars, W M C M

AU - Vriens, M R

AU - Karakatsanis, A

AU - Hellman, P

AU - Sywak, M S

AU - van Leeuwen, B L

AU - El Moumni, M

AU - Kruijff, S

PY - 2018/4

Y1 - 2018/4

N2 - BACKGROUND: Posterior retroperitoneoscopic adrenalectomy has gained international popularity in the past decade. Despite major advantages, including shorter duration of operation, minimal blood loss and decreased postoperative pain, many surgeons still prefer laparoscopic transperitoneal adrenalectomy. It is likely that the unfamiliar anatomical environment, smaller working space and long learning curve impede implementation. The present study assessed the number of procedures required to fulfil the surgical learning curve for posterior retroperitoneoscopic adrenalectomy.METHODS: The first consecutive posterior retroperitoneoscopic adrenalectomies performed by four surgical teams from university centres in three different countries were analysed. The primary outcome measure was duration of operation. Secondary outcomes were conversion to an open or laparoscopic transperitoneal approach, complications and recovery time. The learning curve cumulative sum (LC-CUSUM) was used to assess the learning curves for each surgical team.RESULTS: A total of 181 surgical procedures performed by four surgical teams were analysed. The median age of the patients was 57 (range 15-84) years and 61·3 per cent were female. Median tumour size was 25 (range 4-85) mm. There were no significant differences in patient characteristics and tumour size between the teams. The median duration of operation was 89 (range 29-265) min. There were 35 perioperative and postoperative complications among the 181 patients (18·8 per cent); 17 of 27 postoperative complications were grade 1. A total of nine conversions to open procedures (5·0 per cent) were observed. The LC-CUSUM analysis showed that competency was achieved after a range of 24-42 procedures.CONCLUSION: In specialized endocrine surgical centres between 24 and 42 procedures are required to fulfil the entire surgical learning curve for the posterior retroperitoneoscopic adrenalectomy.

AB - BACKGROUND: Posterior retroperitoneoscopic adrenalectomy has gained international popularity in the past decade. Despite major advantages, including shorter duration of operation, minimal blood loss and decreased postoperative pain, many surgeons still prefer laparoscopic transperitoneal adrenalectomy. It is likely that the unfamiliar anatomical environment, smaller working space and long learning curve impede implementation. The present study assessed the number of procedures required to fulfil the surgical learning curve for posterior retroperitoneoscopic adrenalectomy.METHODS: The first consecutive posterior retroperitoneoscopic adrenalectomies performed by four surgical teams from university centres in three different countries were analysed. The primary outcome measure was duration of operation. Secondary outcomes were conversion to an open or laparoscopic transperitoneal approach, complications and recovery time. The learning curve cumulative sum (LC-CUSUM) was used to assess the learning curves for each surgical team.RESULTS: A total of 181 surgical procedures performed by four surgical teams were analysed. The median age of the patients was 57 (range 15-84) years and 61·3 per cent were female. Median tumour size was 25 (range 4-85) mm. There were no significant differences in patient characteristics and tumour size between the teams. The median duration of operation was 89 (range 29-265) min. There were 35 perioperative and postoperative complications among the 181 patients (18·8 per cent); 17 of 27 postoperative complications were grade 1. A total of nine conversions to open procedures (5·0 per cent) were observed. The LC-CUSUM analysis showed that competency was achieved after a range of 24-42 procedures.CONCLUSION: In specialized endocrine surgical centres between 24 and 42 procedures are required to fulfil the entire surgical learning curve for the posterior retroperitoneoscopic adrenalectomy.

KW - Adrenal Gland Neoplasms/surgery

KW - Adrenalectomy/education

KW - Adult

KW - Aged

KW - Aged, 80 and over

KW - Female

KW - Humans

KW - Laparoscopy/education

KW - Learning Curve

KW - Male

KW - Middle Aged

KW - New South Wales

KW - Operative Time

KW - Retroperitoneal Space

KW - Young Adult

U2 - 10.1002/bjs.10740

DO - 10.1002/bjs.10740

M3 - Article

C2 - 29493779

SN - 0007-1323

VL - 105

SP - 544

EP - 551

JO - British Journal of Surgery

JF - British Journal of Surgery

IS - 5

ER -

Multicentre study evaluating the surgical learning curve for posterior retroperitoneoscopic adrenalectomy

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