Multicentre study evaluating the surgical learning curve for posterior retroperitoneoscopic adrenalectomy

Area of Science:

• Surgical innovation and minimally invasive techniques.
• Endocrine surgery and adrenal gland procedures.
• Medical education and surgical skill acquisition.

Background:

• Posterior retroperitoneoscopic adrenalectomy is increasingly popular due to its advantages.
• Surgeons often prefer traditional laparoscopic transperitoneal adrenalectomy due to unfamiliar anatomy and a steep learning curve.
• This study investigates the learning curve for posterior retroperitoneoscopic adrenalectomy.

Purpose of the Study:

• To determine the number of procedures required to achieve surgical competency in posterior retroperitoneoscopic adrenalectomy.
• To analyze the learning curve for surgeons performing this minimally invasive procedure.
• To identify factors influencing the adoption of posterior retroperitoneoscopic adrenalectomy.

Main Methods:

• Analysis of 181 consecutive posterior retroperitoneoscopic adrenalectomies from four international university surgical teams.
• Primary outcome: duration of operation; Secondary outcomes: conversion rates, complications, and recovery.
• Learning Curve-Cumulative Sum (LC-CUSUM) analysis was used to assess proficiency.

Main Results:

• A total of 181 procedures were analyzed, with no significant differences in patient or tumor characteristics across teams.
• The median operative duration was 89 minutes, with an 18.8% complication rate and a 5.0% conversion rate to open surgery.
• LC-CUSUM analysis indicated that surgical competency was achieved between 24 and 42 procedures per team.

Conclusions:

• Mastery of posterior retroperitoneoscopic adrenalectomy requires a dedicated learning period.
• Between 24 and 42 procedures are necessary to complete the learning curve in specialized endocrine surgical centers.
• This data provides a benchmark for training and implementation of this minimally invasive adrenalectomy technique.