Learning Curve And Perioperative Outcomes Analysis In Modified Anatomical Retroperitoneoscopic Adrenalectomy

Objective:Compared with modified anatomical retroperitoneoscopic adrenalectomy(MARA)and modified anatomical retroperitoneoscopic adrenalectomy(ARA),to evaluate and discuss the learning curve and advantage of modified anatomical retroperitoneoscopic adrenalectomy.Methods:From January 2016 to January 2019,the data from 94 consecutive patients,among them,48 cases had undergone modified anatomical retroperitoneoscopic adrenalectomy(MARA),46 cases had undergone anatomical retroperitoneoscopic adrenalectomy(ARA),were retrospectively analyzed.Statistic related parameters such as age,gender,body mass index(BMI),operation time,intraoperative blood loss,24hours postoperative peritoneal drainage,and average postoperative hospital stay.The group of MARA patients underwent modified laparoscopic anatomical adrenal(tumor)resection under the same operation.And they were divided into three groups A,B,and C according to the time sequence of operation:Group A 16 cases(1 to 16 cases),Group B 16 patients(17 to 32 patients),Group C 16 patients(33 to 48 patients).The group of ARA was operated by other surgeons with the same age and experience in our department.Compared with the difference of parameters included age,BMI,maximum tumor diameter,operation time,intraoperative blood loss,24 hours drainage quantity after operation and hospital stay between the groups MARA and ARA.Analyzed the correlation between the number of surgical cases in the MARA group and perioperative parameters such as operative time,intraoperative blood loss,24 hours drainage quantity after operation and hospital stay.Resullts:All the operations were successfully completed,and the patients recovered well without serious complications.The group of MARA average operation time was46.27±12.7min,the average intraoperative blood loss was 40.96±13.42ml,the average 24-hour postoperative peritoneal drainage was 26.46±12.13ml,and the average postoperative hospital stay was 2.60±0.54 d.The group of ARA average operation time was 79.72±16.60min,the average intraoperative blood loss was50.43±14.33ml,the average 24-hour postoperative peritoneal drainage was 57.78±31.83ml,and the average postoperative hospital stay was 4.83±1.68 d.Compared with the ARA group,the operation time,intraoperative blood loss,24 hours drainage quantity after operation and hospital stay were significantly shorter in the MARA group.And the differences had statistically significant(P<0.05).In MARA group,with the increase in the number of surgical cases,the operation time was significantly shortened(?r_s?=0.82,P<0.01),the intraoperative blood loss(?r_s?=0.95,P<0.01)and the retroperitoneal drainage volume(?r_s?=0.94,P<0.01)decreased significantly,and the number of postoperative hospital stays(?r_s?=0.16,P>0.05)did not change significantly.Group A(59.37±3.98min)had more average operation time than that of group B(46.75±5.63min)and group C(32.69±8.85min).Group A(56.88±3.41ml)had more intraoperative blood loss than that of group B(40.81±0.75ml)and group C(25.19±4.04ml).Group A(40.75±5.98ml)had more drainage quantity than that of group B(25.75±2.75ml)and group C(12.87±1.50ml).The one-way analysis of variance revealed statistically significant differences in the three groups A,B,and C(P<0.05).And the analysis was performed between two pairs used an independent sample t test.The results suggested that there were statistically significant differences between group A and group B or group A and group C or group B and group C(P<0.05).But the average postoperative hospital stay of Group A(2.81±0.54 d),Group B(2.44±0.51d),Group C(2.56±0.51 d),there were no significant differences between the three groups and also had no significant differences between Group A and Group B or Group B and Group C or Group C and Group A(P>0.05).Conclusion:Compared to ARA group,the group of MARA is more safe and effective.With the increase of the number of surgical procedures,the operation time was significantly shortened,the intraoperative blood loss and 24 hours drainage quantity after operation could be significantly reduced.After 16 cases of MARA for beginners,the operation time could be shortened significantly,and the amount of bleeding during the operation was significantly reduced.After 32 cases of surgery,the operation time and the amount of bleeding during the operation could be stable.