Laura Alberici1,2, Claudio Ricci3,4,5, Carlo Ingaldi1,2, Riccardo Casadei1,2, Riccardo Turrini1, Guido Di Dalmazi1,6, Valentina Vicennati1,6, Uberto Pagotto1,6, Saverio Selva2, Francesco Minni1,2. 1. Department of Medical and Surgical Science (DIMEC), University of Bologna, Alma Mater Studiorum, Bologna, Italy. 2. General Surgery Unit, S. Orsola-Malpighi Hospital, Bologna, Italy. 3. Department of Medical and Surgical Science (DIMEC), University of Bologna, Alma Mater Studiorum, Bologna, Italy. claudiochir@gmail.com. 4. General Surgery Unit, S. Orsola-Malpighi Hospital, Bologna, Italy. claudiochir@gmail.com. 5. 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. claudiochir@gmail.com. 6. Endocrinology and Diabetes Prevention and Care Unit, S. Orsola-Malpighi Hospital, Bologna, Italy.
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.
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.
Authors: F Nicolì; G Lanzolla; M Mantuano; I Ionni; B Mazzi; M Leo; A Sframeli; C Posarelli; M N Maglionico; M Figus; M Nardi; C Marcocci; M Marinò Journal: J Endocrinol Invest Date: 2020-07-09 Impact factor: 4.256
Authors: Laura Alberici; Alessandro M Paganini; Francesco Minni; Guido Alberto Massimo Tiberio; Claudio Ricci; Andrea Balla; Zeno Ballarini; Monica Ortenzi; Giovanni Casole; Silvia Quaresima; Guido Di Dalmazi; Pietro Ursi; Marie Sophie Alfano; Saverio Selva; Riccardo Casadei; Carlo Ingaldi; Giovanni Lezoche; Mario Guerrieri Journal: Surg Endosc Date: 2021-08-17 Impact factor: 4.584