New predictive factors for prolonged operation time of laparoscopic posterior retroperitoneal adrenalectomy; retrospective cohort study

Abstract

BackgroundLaparoscopic adrenalectomy is a standard surgical procedure for benign adrenal diseases. Laparoscopic posterior retroperitoneal adrenalectomy (LPRA) has many benefits. However, it is associated with factors such as prolong operation time. The aim of the study was to determine the predictive factors associated with prolonged operation time in LPRA. Materials and methodsThis study retrospectively analyzed data from 284 patients who underwent LPRA between 2014 and 2019 at Asan Medical Center. Then, we analyzed the predictive factors prolonging operation time using multivariate logistic regression analysis and classified the differences according to the learning curve using cumulative sum analysis. ResultsIn multivariate logistic regression analysis, the following were determined as factors associated with prolonged operation time: male sex (OR, 2.540; 95% CI, 1.225–5.266), pheochromocytoma (OR, 3.669; 95% CI, 1.548–8.694), right site (OR, 2.499; 95% CI, 1.086–5.748), surgeon A (OR, 3.293; 95% CI, 1.522–7.122), depth of descended adrenal tumor location to kidney (OR, 3.793; 95% CI, 1.660–8.667), large periadrenal fat volume (OR, 2.366; 95% CI, 1.120–4.996), and posterior adiposity index (PAI) (OR, 2.171; 95% CI, 1.090–4.324) (all p < 0.05). However, in the period after the learning curve, periadrenal fat volume was not a significant predictor of surgery time prolongation. ConclusionThis study demonstrates that depth of descended adrenal tumor location to kidney is a new and important independent predictive factor for prolonged operation time in LPRA. In addition, periadrenal fat volume is a predictor of surgery time prolongation for beginner surgeons before the learning curve.