Defining the learning curve of laparoscopic adrenalectomy: a single-center experience

Laparoscopic adrenalectomy has become the standard approach for most benign adrenal lesions. However, the number of cases required for a surgeon to achieve proficiency remains debated, as learning curves vary according to patient characteristics, lesion factors, and surgeon experience. This study aims to evaluate learning curve for laparoscopic adrenalectomy and identified factors influencing operative duration in a single-surgeon experience. This is a retrospective observational cohort study that evaluated 70 consecutive unilateral laparoscopic adrenalectomies performed via the lateral transperitoneal approach. Patient demographics, tumor characteristics, and perioperative variables were collected. Univariate analysis was followed by multivariable linear regression to determine factors associated with operative duration. The learning curve was assessed using moving average smoothing, Cumulative Sum Control Chart, and segmented regression of operative duration against case sequence. A second segmented analysis was performed on the multivariable model incorporating preoperative and intraoperative factors associated with operative duration. The cohort had a mean age of 46 ± 15.8 years, with 71.4% being females. The median surgery duration was 120 min (IQR: 67.5) with a mean of 123 ± 53.7 min. On multivariable analysis, larger tumor size ( P = 0.01) and greater intraoperative blood loss ( P < 0.001) were independently associated with longer operative durations. Learning curve analysis demonstrated a significant reduction in operative duration ( P = 0.01) with a breakpoint at 23 cases. A secondary multivariable model incorporating both preoperative and intraoperative factors identified a later breakpoint at 32.7 cases, reflecting the combined influence of experience and operative conditions. A learning curve was observed, with operative duration improving after approximately 23 cases. A secondary multivariable model identified a later model-based breakpoint at around 33 cases. These findings should be interpreted as cohort-specific estimates and suggest that learning-curve interpretation in laparoscopic adrenalectomy should consider both accumulated experience and operative factors that influence surgical performance.