The learning curve of laparoendoscopic single-site adrenalectomy: an analysis of over 100 cases

Keishiro Fukumoto, Akira Miyajima, Seiya Hattori, Kazuhiro Matsumoto, Takayuki Abe, Isao Kurihara, Masahiro Jinzaki, Eiji Kikuchi, Mototsugu Oya

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Background: Recently, laparoendoscopic single-site adrenalectomy (LESS-A) has been developed as an alternative treatment for adrenal tumors. Although LESS-A is more technically complex than conventional laparoscopic adrenalectomy, its learning curve and the factors associated with poor surgical outcomes are poorly understood. We analyzed the learning curve of LESS-A and attempted to identify risk factors associated with worse surgical outcomes. Methods: We identified 103 patients who underwent LESS-A [performed by the same surgeon (A.M.)] from 2009 to 2015. The learning curve was analyzed using the moving average method (the 10-case moving average), and we assessed potential risk factors for a prolonged pneumoperitoneum time. Results: The learning curve stabilized at 30 cases. The cases were divided into two groups, the learning stage (LS) (cases 1–29) and master stage (MS) (cases 30–103) groups. The percentage of females and the frequency of previous abdominal surgery were higher in the LS group (p = 0.022 and 0.001, respectively). In the LS group, the mean pneumoperitoneum time was 92 ± 35 min, which was significantly longer than the equivalent value for the MS group (55 ± 18 min, p <0.001). In the LS group, univariate analysis revealed that tumor size (≥50 mm) and the visceral fat area (VFA)/total fat area (TFA) ratio (≥0.49) were significantly associated with a prolonged pneumoperitoneum time (p = 0.046 and 0.046, respectively). In the multivariate analysis, tumor size and the VFA/TFA ratio were confirmed to be associated with a prolonged pneumoperitoneum time (p = 0.029 and 0.029, odds ratio 20.83 and 20.83, respectively). On the other hand, none of the examined factors were found to be associated with a prolonged pneumoperitoneum time in the MS group. Conclusions: LESS-A was performed safely in most cases. However, surgeons who are learning the LESS-A procedure need to pay attention to tumor size and visceral obesity.

Original languageEnglish
Pages (from-to)1-8
Number of pages8
JournalSurgical Endoscopy and Other Interventional Techniques
DOIs
Publication statusAccepted/In press - 2016 May 18

Fingerprint

Learning Curve
Adrenalectomy
Pneumoperitoneum
Learning
Intra-Abdominal Fat
Fats
Neoplasms
Glandular and Epithelial Neoplasms
Abdominal Obesity
Multivariate Analysis
Odds Ratio

Keywords

  • Laparoendoscopic single-site adrenalectomy
  • Laparoendoscopic single-site surgery
  • Learning curve
  • Surgical outcome

ASJC Scopus subject areas

  • Surgery

Cite this

The learning curve of laparoendoscopic single-site adrenalectomy : an analysis of over 100 cases. / Fukumoto, Keishiro; Miyajima, Akira; Hattori, Seiya; Matsumoto, Kazuhiro; Abe, Takayuki; Kurihara, Isao; Jinzaki, Masahiro; Kikuchi, Eiji; Oya, Mototsugu.

In: Surgical Endoscopy and Other Interventional Techniques, 18.05.2016, p. 1-8.

Research output: Contribution to journalArticle

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abstract = "Background: Recently, laparoendoscopic single-site adrenalectomy (LESS-A) has been developed as an alternative treatment for adrenal tumors. Although LESS-A is more technically complex than conventional laparoscopic adrenalectomy, its learning curve and the factors associated with poor surgical outcomes are poorly understood. We analyzed the learning curve of LESS-A and attempted to identify risk factors associated with worse surgical outcomes. Methods: We identified 103 patients who underwent LESS-A [performed by the same surgeon (A.M.)] from 2009 to 2015. The learning curve was analyzed using the moving average method (the 10-case moving average), and we assessed potential risk factors for a prolonged pneumoperitoneum time. Results: The learning curve stabilized at 30 cases. The cases were divided into two groups, the learning stage (LS) (cases 1–29) and master stage (MS) (cases 30–103) groups. The percentage of females and the frequency of previous abdominal surgery were higher in the LS group (p = 0.022 and 0.001, respectively). In the LS group, the mean pneumoperitoneum time was 92 ± 35 min, which was significantly longer than the equivalent value for the MS group (55 ± 18 min, p <0.001). In the LS group, univariate analysis revealed that tumor size (≥50 mm) and the visceral fat area (VFA)/total fat area (TFA) ratio (≥0.49) were significantly associated with a prolonged pneumoperitoneum time (p = 0.046 and 0.046, respectively). In the multivariate analysis, tumor size and the VFA/TFA ratio were confirmed to be associated with a prolonged pneumoperitoneum time (p = 0.029 and 0.029, odds ratio 20.83 and 20.83, respectively). On the other hand, none of the examined factors were found to be associated with a prolonged pneumoperitoneum time in the MS group. Conclusions: LESS-A was performed safely in most cases. However, surgeons who are learning the LESS-A procedure need to pay attention to tumor size and visceral obesity.",
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author = "Keishiro Fukumoto and Akira Miyajima and Seiya Hattori and Kazuhiro Matsumoto and Takayuki Abe and Isao Kurihara and Masahiro Jinzaki and Eiji Kikuchi and Mototsugu Oya",
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T1 - The learning curve of laparoendoscopic single-site adrenalectomy

T2 - an analysis of over 100 cases

AU - Fukumoto, Keishiro

AU - Miyajima, Akira

AU - Hattori, Seiya

AU - Matsumoto, Kazuhiro

AU - Abe, Takayuki

AU - Kurihara, Isao

AU - Jinzaki, Masahiro

AU - Kikuchi, Eiji

AU - Oya, Mototsugu

PY - 2016/5/18

Y1 - 2016/5/18

N2 - Background: Recently, laparoendoscopic single-site adrenalectomy (LESS-A) has been developed as an alternative treatment for adrenal tumors. Although LESS-A is more technically complex than conventional laparoscopic adrenalectomy, its learning curve and the factors associated with poor surgical outcomes are poorly understood. We analyzed the learning curve of LESS-A and attempted to identify risk factors associated with worse surgical outcomes. Methods: We identified 103 patients who underwent LESS-A [performed by the same surgeon (A.M.)] from 2009 to 2015. The learning curve was analyzed using the moving average method (the 10-case moving average), and we assessed potential risk factors for a prolonged pneumoperitoneum time. Results: The learning curve stabilized at 30 cases. The cases were divided into two groups, the learning stage (LS) (cases 1–29) and master stage (MS) (cases 30–103) groups. The percentage of females and the frequency of previous abdominal surgery were higher in the LS group (p = 0.022 and 0.001, respectively). In the LS group, the mean pneumoperitoneum time was 92 ± 35 min, which was significantly longer than the equivalent value for the MS group (55 ± 18 min, p <0.001). In the LS group, univariate analysis revealed that tumor size (≥50 mm) and the visceral fat area (VFA)/total fat area (TFA) ratio (≥0.49) were significantly associated with a prolonged pneumoperitoneum time (p = 0.046 and 0.046, respectively). In the multivariate analysis, tumor size and the VFA/TFA ratio were confirmed to be associated with a prolonged pneumoperitoneum time (p = 0.029 and 0.029, odds ratio 20.83 and 20.83, respectively). On the other hand, none of the examined factors were found to be associated with a prolonged pneumoperitoneum time in the MS group. Conclusions: LESS-A was performed safely in most cases. However, surgeons who are learning the LESS-A procedure need to pay attention to tumor size and visceral obesity.

AB - Background: Recently, laparoendoscopic single-site adrenalectomy (LESS-A) has been developed as an alternative treatment for adrenal tumors. Although LESS-A is more technically complex than conventional laparoscopic adrenalectomy, its learning curve and the factors associated with poor surgical outcomes are poorly understood. We analyzed the learning curve of LESS-A and attempted to identify risk factors associated with worse surgical outcomes. Methods: We identified 103 patients who underwent LESS-A [performed by the same surgeon (A.M.)] from 2009 to 2015. The learning curve was analyzed using the moving average method (the 10-case moving average), and we assessed potential risk factors for a prolonged pneumoperitoneum time. Results: The learning curve stabilized at 30 cases. The cases were divided into two groups, the learning stage (LS) (cases 1–29) and master stage (MS) (cases 30–103) groups. The percentage of females and the frequency of previous abdominal surgery were higher in the LS group (p = 0.022 and 0.001, respectively). In the LS group, the mean pneumoperitoneum time was 92 ± 35 min, which was significantly longer than the equivalent value for the MS group (55 ± 18 min, p <0.001). In the LS group, univariate analysis revealed that tumor size (≥50 mm) and the visceral fat area (VFA)/total fat area (TFA) ratio (≥0.49) were significantly associated with a prolonged pneumoperitoneum time (p = 0.046 and 0.046, respectively). In the multivariate analysis, tumor size and the VFA/TFA ratio were confirmed to be associated with a prolonged pneumoperitoneum time (p = 0.029 and 0.029, odds ratio 20.83 and 20.83, respectively). On the other hand, none of the examined factors were found to be associated with a prolonged pneumoperitoneum time in the MS group. Conclusions: LESS-A was performed safely in most cases. However, surgeons who are learning the LESS-A procedure need to pay attention to tumor size and visceral obesity.

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KW - Laparoendoscopic single-site surgery

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KW - Surgical outcome

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