机器人肾上腺切除术是可行和安全的，但对手术时间增加和掌握技术的学习曲线（LC）的担忧限制了它的采用。本研究旨在评估机器人肾上腺切除术的学习曲线。这是两个医疗机构的连续单侧微创肾上腺切除手术回顾性研究，由四名高容量肾上腺外科医生在2007年至2022年间执行。两名外科医生从腹腔镜肾上腺切除手术转变为机器人肾上腺切除手术，另外两名外科医生在完成研究生培训后开始采用这种方法，并进行辅导。分析手术时间和并发症。使用多元回归分析识别与手术时间相关的因素。采用LC-cumulative-sum（LC-CUSUM）分析确定克服LC所需的病例数。在457例肾上腺切除手术中，182例（40％）为腹腔镜手术，275例（60％）为机器人手术。机器人手术与较短的介入时间中位数（106比119分钟；p = 0.002），较少的并发症（6％比13％；p = 0.018）和较少的开放性肾上腺切除转化率（1％比4％；p = 0.030）相关联，而高年资和低年资的外科医生之间没有区别。在调整分析中，与手术时间增加有关的因素是男性（p <0.001），BMI> 30 kg/m2（p <0.001）和更高的腺体重量（p <0.001）。LC-CUSUM分析显示了在执行8-29例手术后就能够掌握这项技术。与前10例相比，无论外科医生的经验如何，进行了10-20例手术后手术时间平均减少了14分钟，在20-30例手术后减少了28分钟，在> 30例手术后减少了29分钟。在高容量医疗中心，通过专业团队和辅导，机器人肾上腺切除术可以安全地采用，并且学习曲线很小。© 2023年。手术肿瘤学会。

Robotic adrenalectomy is feasible and safe, yet concerns over increased operative times and the learning curve (LC) for proficiency have limited its adoption. This study aimed to assess the LC for robotic adrenalectomy.This is a two-institution retrospective review of consecutive unilateral minimally invasive adrenalectomies performed by four high-volume adrenal surgeons between 2007 and 2022. Two surgeons transitioned from laparoscopic to robotic adrenalectomy, and two surgeons adopted the approach, with proctoring, after completion of fellowship training without robotic experience. Operative time and complications were analyzed. Multivariable regression was used to identify factors associated with operative time. The number of cases required to overcome the LC was determined using the LC-cumulative-sum (LC-CUSUM) analysis.Of 457 adrenalectomies, 182 (40%) were laparoscopic and 275 (60%) robotic. The robotic approach was associated with shorter median operative time (106 vs 119 min; p = 0.002), fewer complications (6% vs 13%; p = 0.018), and fewer conversions to open adrenalectomy (1% vs 4%; p = 0.030), with no difference between the senior and junior surgeons. On adjusted analysis, factors associated with increased operative time were male sex (p < 0.001), BMI > 30 kg/m2 (p < 0.001), and higher gland weight (p < 0.001). The LC-CUSUM analysis showed proficiency after 8-29 procedures. Compared with the first 10 cases, there was a mean reduction in operative time of 14 min after 10-20 cases, 28 min after 20-30 cases, and 29 min after > 30 cases, regardless of surgeon experience.With dedicated teams and proctoring, robotic adrenalectomy can be safely adopted at high-volume centers with a minimal LC.© 2023. Society of Surgical Oncology.