Three-dimensional laparoscopic adrenalectomy is feasible and safe, yet concerns over increased operative times and learning curve (LC) for proficiency have limited its adoption. This study aimed to assess the LC for 3D laparoscopic adrenalectomy (3D-LA).

This is a retrospective review (between January 2013 and May 2022) of consecutive unilateral 100 3D-LAs performed by one high-volume adrenal surgeon (he transitioned from 2D laparoscopy to 3D laparoscopy). Operative time (primary outcome), conversion to open surgery, complications, and hospital stay (secondary outcomes) were analyzed. The number of cases required to overcome the LC was determined using the LC-cumulative-sum (CUSUM) curve analysis.

Patients' median age was 56 years (range 16‒78); 57 (57%) were female. Median tumor size was 5 cm (range 1.5‒14). Median operative time was 55 min (range 20‒150). Only 1 (1%) procedure required conversion to open surgery, and only 2 (2%) postoperative complications were observed. Median length of stay was 2 days (range 1‒6). No mortality was observed in 30 days. CUSUM analysis of operative time delineated three phases: learning (first 22 cases), competence (following 7 cases), and mastery (remaining 71 cases). Operative time and hospital stays decreased as the surgeon acquired more experience (p<0.001) (to overcome the OT learning curve, 22 cases were needed; for the CUSUM LOS chart, 32 cases were needed); however, other indicators did not differ significantly among phases.

With dedicated endocrine surgeons, 3D laparoscopic adrenalectomy can be safely adopted at high-volume centers with a shorter learning curve.