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The learning curve for the second generation of laparoscopic surgeons: lesson learned from a large series of laparoscopic adrenalectomies

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Abstract

Background

Laparoscopic adrenalectomy has a well-demonstrated learning curve in the first generation of laparoscopic surgeons. Data about the second generation of laparoscopic surgeons are lacking.

Methods

In this retrospective observational study, data from patients undergoing laparoscopic adrenalectomy from 2000 to 2019 in a high-volume center were collected and analyzed. The cumulative sum of procedures of each surgeon and the operating time were evaluated. A multivariate analysis with backward stepwise logistic regression was carried out to define which factors influenced the operative time. Three surgeons performed the analyzed procedures: a senior surgeon who began his laparoscopic activity without receiving specific training or supervision and two young surgeons, who performed their procedures under the guidance of the “senior” experienced surgeon. The first 38 procedures of the three surgeons were then compared.

Results

A total of 244 laparoscopic adrenalectomies were performed. Age, clinical diagnosis, side of the lesion, body mass index, comorbidities, Charlson index, American Society of Anaesthesiologists (ASA) score, and lower abdominal surgery were found to have no significant relationship with the operative time (p > 0.05). Gender, symptoms, previous upper abdominal surgery, size of the lesion, and cumulative sum of procedures were independent predictors of operative time. In the comparison between different surgeons, operative time resulted significantly longer for the senior (165 min; 140–180) than for the two junior surgeons (137.5 min; 115–160; p = 0.003 and 130 min; 120–170; p = 0.001).

Conclusions

The presence of a mentor in operative theater and specific training programs could be useful during the learning period. The cumulative sum of procedures related to the operative time represents a good parameter to measure the acquired expertise of a surgeon.

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Acknowledgements

We would like to thank Dott. Nicola Marrano for his contribution.

Funding

The authors did not receive funding for the manuscript.

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Authors and Affiliations

  1. Department of Medical and Surgical Science (DIMEC), University of Bologna, Alma Mater Studiorum, Bologna, Italy

    Laura Alberici, Claudio Ricci, Carlo Ingaldi, Riccardo Casadei, Riccardo Turrini, Guido Di Dalmazi, Valentina Vicennati, Uberto Pagotto & Francesco Minni

  2. General Surgery Unit, S. Orsola-Malpighi Hospital, Bologna, Italy

    Laura Alberici, Claudio Ricci, Carlo Ingaldi, Riccardo Casadei, Saverio Selva & Francesco Minni

  3. Endocrinology and Diabetes Prevention and Care Unit, S. Orsola-Malpighi Hospital, Bologna, Italy

    Guido Di Dalmazi, Valentina Vicennati & Uberto Pagotto

  4. Department of Medical and Surgical Science (DIMEC), University of Bologna, Alma Mater Studiorum, General Surgical Unit, S.Orsola-Malpighi Hospital, Via Massarenti n.9, 40138, Bologna, Italy

    Claudio Ricci

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  1. Laura Alberici
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Correspondence to Claudio Ricci.

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Disclosures

Laura Alberici, Claudio Ricci, Carlo Ingaldi, Riccardo Casadei, Riccardo Turrini, Guido Di Dalmazi, Valentina Vicennati, Uberto Pagotto, Saverio Selva, and Francesco Minni declare that they have no conflicts of interest.

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Alberici, L., Ricci, C., Ingaldi, C. et al. The learning curve for the second generation of laparoscopic surgeons: lesson learned from a large series of laparoscopic adrenalectomies. Surg Endosc 35, 2914–2920 (2021). https://doi.org/10.1007/s00464-020-07730-1

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  • DOI: https://doi.org/10.1007/s00464-020-07730-1

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