Learning Curve and Conversion to Open Surgery in Cases of Laparoscopic Adrenalectomy and Nephrectomy

No AccessJournal of UrologyClinical Urology: Original Articles1 Mar 1998LEARNING CURVE AND CONVERSION TO OPEN SURGERY IN CASES OF LAPAROSCOPIC ADRENALECTOMY AND NEPHRECTOMY EIJI HIGASHIHARA, SHIRO BABA, KEN NAKAGAWA, MASARU MURAI, HIDETO GO, MASAYUKI TAKEDA, KOTA TAKAHASHI, KAZUO SUZUKI, KIMIO FUJITA, YOSHINARI ONO, SHINICHI OHSHIMA, TADASHI MATSUDA, TOSHIRO TERACHI, and OSAMU YOSHIDA EIJI HIGASHIHARAEIJI HIGASHIHARA , SHIRO BABASHIRO BABA , KEN NAKAGAWAKEN NAKAGAWA , MASARU MURAIMASARU MURAI , HIDETO GOHIDETO GO , MASAYUKI TAKEDAMASAYUKI TAKEDA , KOTA TAKAHASHIKOTA TAKAHASHI , KAZUO SUZUKIKAZUO SUZUKI , KIMIO FUJITAKIMIO FUJITA , YOSHINARI ONOYOSHINARI ONO , SHINICHI OHSHIMASHINICHI OHSHIMA , TADASHI MATSUDATADASHI MATSUDA , TOSHIRO TERACHITOSHIRO TERACHI , and OSAMU YOSHIDAOSAMU YOSHIDA View All Author Informationhttps://doi.org/10.1016/S0022-5347(01)63693-0AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: We examine how the level of experience acquired by the laparoscopist affects the outcome of laparoscopic adrenalectomy and nephrectomy, and what is necessary to avoid complications in these surgeries. Materials and Methods: We retrospectively evaluated the experience levels of 8 urological laparoscopists between 1991 and 1995. In addition, other cases that were converted to open surgery were collected from the institutes with which the 8 laparoscopists were affiliated. Results: The rates of conversion to open surgery were 6.4% in 204 cases of adrenalectomy and 14.3% in 63 of nephrectomy. Conversion rates were related to blood loss volume but not operative time. The major causes of conversion were bleeding in 45% of cases and adhesion in 34%. There were no mortalities. Mean operative time decreased significantly, reaching that of open surgery as the number of procedures increased up to 20 adrenalectomies and 10 nephrectomies. The volume of blood lost remained low from the early experience. Blood transfusion rates were 4.4% for adrenalectomy and 11.1% for nephrectomy. Conclusions: Operative time of these procedures decreased significantly with surgeon experience and reached that of open surgery. Cases in which adhesion is anticipated should be restricted to avoid conversion. These laparoscopic procedures are acceptable as a standard operative techniques for adrenal and renal diseases. References 1 : Laparoscopic nephrectomy: initial case report. J. Urol.1991; 146: 278. Link, Google Scholar 2 : A case report of laparoscopic adrenalectomy. Jap. J. Urol.1992; 83: 1130. Google Scholar 3 : Laparoscopic adrenalectomy: the initial 3 cases. J. Urol.1993; 149: 973. Link, Google Scholar 4 : Laparoscopic adrenalectomy: clinical experience with 12 cases. J. Urol.1993; 150: 1099. Abstract, Google Scholar 5 : Laparoscopic adrenalectomy: the surgical technique and initial results of 13 cases. Min. Invas. Ther.1993; 2: 123. Google Scholar 6 : Laparoscopic adrenalectomy for primary aldosteronism: a new operative method. J. Laparoendosc. Surg.1993; 3: 455. 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Abstract, Google Scholar From the Departments of Urology, Kyorin University School of Medicine and Keio University School of Medicine, Tokyo, Niigata University School of Medicine, Niigata, Hamamatsu University School of Medicine, Hamamatsu, Komaki Shimin Hospital, Komaki, Nagoya University School of Medicine, Nagoya, Kansai Medical School, Osaka and Kyoto University School of Medicine, Kyoto, Japan.© 1998 by American Urological Association, Inc.FiguresReferencesRelatedDetailsCited byRowley M and Wolf J (2018) Risk Factors for Conversion to Hand Assisted Laparoscopy or Open Surgery During Laparoscopic Renal SurgeryJournal of Urology, VOL. 185, NO. 3, (940-944), Online publication date: 1-Mar-2011.Richstone L, Seideman C, Baldinger L, Permpongkosol S, Jarrett T, Su L, Pavlovich C and Kavoussi L (2018) Conversion During Laparoscopic Surgery: Frequency, Indications and Risk FactorsJournal of Urology, VOL. 180, NO. 3, (855-859), Online publication date: 1-Sep-2008.HOLLENBECK B, SEIFMAN B and WOLF J (2018) Clinical Skills Acquisition for Hand-Assisted Laparoscopic Donor NephrectomyJournal of Urology, VOL. 171, NO. 1, (35-39), Online publication date: 1-Jan-2004.Vallancien G, Cathelineau X, Baumert H, Doublet J and Guillonneau B (2018) Complications of Transperitoneal Laparoscopic Surgery in Urology: Review of 1,311 Procedures at a Single CenterJournal of Urology, VOL. 168, NO. 1, (23-26), Online publication date: 1-Jul-2002.SUZUKI K, KAGEYAMA S, HIRANO Y, USHIYAMA T, RAJAMAHANTY S and FUJITA K (2018) COMPARISON OF 3 SURGICAL APPROACHES TO LAPAROSCOPIC ADRENALECTOMY: A NONRANDOMIZED, BACKGROUND MATCHED ANALYSISJournal of Urology, VOL. 166, NO. 2, (437-443), Online publication date: 1-Aug-2001.SALOMON L, SOULÉ M, MOULY P, SAINT F, CICCO A, OLSSON E, HOZNEK A, ANTIPHON P, CHOPIN D, PLANTE P and ABBOU C (2018) EXPERIENCE WITH RETROPERITONEAL LAPAROSCOPIC ADRENALECTOMY IN 115 PROCEDURESJournal of Urology, VOL. 166, NO. 1, (38-41), Online publication date: 1-Jul-2001.PAUTLER S, McWILLIAMS G, HARRINGTON F and WALTHER M (2018) AN ARTICULATING RETRACTOR HOLDER TO FACILITATE LAPAROSCOPIC ADRENALECTOMY AND NEPHRECTOMYJournal of Urology, VOL. 166, NO. 1, (198-199), Online publication date: 1-Jul-2001.SOULIE M, SEGUIN P, RICHEUX L, MOULY P, VAZZOLER N, PONTONNIER F and PLANTE P (2018) UROLOGICAL COMPLICATIONS OF LAPAROSCOPIC SURGERY: EXPERIENCE WITH 350 PROCEDURES AT A SINGLE CENTERJournal of Urology, VOL. 165, NO. 6 Part 1, (1960-1963), Online publication date: 1-Jun-2001.Dunn M, Portis A, Shalhav A, Elbahnasy A, Heidorn C, McDougall E and Clayman R (2018) LAPAROSCOPIC VERSUS OPEN RADICAL NEPHRECTOMY: A 9-YEAR EXPERIENCEJournal of Urology, VOL. 164, NO. 4, (1153-1159), Online publication date: 1-Oct-2000. Volume 159Issue 3March 1998Page: 650-653 Advertisement Copyright & Permissions© 1998 by American Urological Association, Inc.MetricsAuthor Information EIJI HIGASHIHARA More articles by this author SHIRO BABA More articles by this author KEN NAKAGAWA More articles by this author MASARU MURAI More articles by this author HIDETO GO More articles by this author MASAYUKI TAKEDA More articles by this author KOTA TAKAHASHI More articles by this author KAZUO SUZUKI More articles by this author KIMIO FUJITA More articles by this author YOSHINARI ONO More articles by this author SHINICHI OHSHIMA More articles by this author TADASHI MATSUDA More articles by this author TOSHIRO TERACHI More articles by this author OSAMU YOSHIDA More articles by this author Expand All Advertisement PDF downloadLoading ...