Author:
Dworak Jadwiga,Wysocki Michał,Rzepa Anna,Natkaniec Michał,Pędziwiatr Michał,Budzyński Andrzej,Major Piotr
Abstract
Abstract
Background
Laparoscopic adrenalectomy (LA) has become the “gold standard” for treating most adrenal tumors in the past decade. However, it is still considered a relatively complicated procedure requiring experience from surgeon. The aim of the study was to evaluate the safety of laparoscopic adrenalectomy performed by residents who are undergoing training in general surgery.
Methods
A prospectively collected database containing all 300 transperitoneal laparoscopic adrenalectomies performed in II Department of General Surgery JU MC, Krakow between January 2013 and March 2018 was retrospectively reviewed. Patients were divided into two groups; patients operated on by residents (group 1, 54 operations) and by attending general surgeons (group 2, 246 operations). We compared the course of the operation and patient hospitalization in these two groups. If the operation was completed by a different person than the one who started the procedure, we refer to this as “operator conversion”.
Results
We found no differences in demographic factors or comorbidities between the two groups. The mean operative time was similar in the residents’ and the specialists’ groups (p = 0.5761). Median blood loss did not differ between the groups (p = 0.4325). The overall ratio of intraoperative adverse events was similar in both groups (p = 0.8643). The difference in the ratio of perioperative complications between the groups was not statistically significant (p = 0.6442). The average mean hospital stay after surgery was 2 days for both groups. We identified 25 cases (8.33%) of operator conversion; the difference in operator conversions between two groups was not statistically significant (p = 0.1741).
Conclusions
Laparoscopic transperitoneal adrenalectomy performed by a supervised resident is a safe procedure. The course of the operation and patient hospitalization did not differ importantly when comparing procedures performed by residents and attending surgeons. Liberal use of operator conversions from resident to attending surgeon and from a surgeon to a senior surgeon provides reasonable safety and prevents complications. In high-volume centers performing minimally invasive techniques, closed supervision allows residents to safely perform LA.
Publisher
Springer Science and Business Media LLC
Subject
Urology,Reproductive Medicine,General Medicine
Reference28 articles.
1. Gagner M, Lacroix A, Bolte E. Laparoscopic adrenalectomy in Cushing’s syndrome and pheochromocytoma. N Engl J Med. 1992;327:1003.
2. Maccabee DL, Jones A, Domreis J, et al. Transition from open to laparoscopic adrenalectomy: the need for advanced training. Surg Endosc. 2003;17:1566–9.
3. Natkaniec M, Pedziwiatr M, Wierdak M, et al. Laparoscopic adrenalectomy for pheochromocytoma is more difficult compared to other adrenal tumors. Wideochir Inne Tech Maloinwazyjne. 2015;10(3):466–71.
4. Pędziwiatr M, Wierdak M, Ostachowski M, et al. Single center outcomes of laparoscopic transperitoneal lateral adrenalectomy - Lessons learned after 500 cases: A retrospective cohort study. Int Surg. 2015;20:88–94.
5. Zhang X, Wang B, Ma X, et al. Laparoscopic adrenalectomy for beginners without open counterpart experience: initial results under staged training. Urology. 2009;73:1061–5.
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