Laparoscopic Adrenalectomy: Assessment of the Surgical Outcomes and Learning Curve for Large Adrenal Tumours

Abstract

Objective: Laparoscopic adrenalectomy (LA) is the treatment of choice for benign tumours of less than 6 cm. However, there is still an ongoing debate regarding the exact cut-off value of the tumour size. The aim of this study was to determine the effect of tumour size on intraoperative and postoperative outcomes in patients undergoing LA and also to estimate the learning curve for large adrenal tumours. Materials and Methods: The data of 102 patients who underwent LA from April 2010 to October 2018 was retrospectively analysed. The patients were allocated to 2 groups according to tumour size: <6 cm (group 1 =76) and >= 6 cm (group 2 =26). Both groups were compared in terms of age, gender, body mass index, tumour characteristics, operative data and complication rates. The patients were also allocated to four groups (A, B, C and D) according to the chronological order of their surgery in order to evaluate the learning curve. Results: The mean age, gender, tumour laterality and BMI were similar in both groups. Tumour size (32.7 vs 79.5 mm, p=0.001), operation time (53.3 vs 72.6 minute, p=0.001), blood loss (65.8 vs 86.35 mL, p=0.042) were significantly different between groups 1 and 2, respectively. Intraoperative and postoperative complication rates were also found to be significantly higher in group 2. The first 25 cases were sufficient to complete the initial learning curve. It showed that surgical experience increased and operation time and blood loss decreased as the mean tumour size that is managed by LA increases. Conclusion: LA is a reliable approach for the management of large adrenal tumours. However, we can conclude that the most important factor determining the safety and efficacy of LA is the surgical experience.