Laparoendoscopic Single-Site Retroperitoneoscopic Adrenalectomy versus Conventional Retroperitoneoscopic Adrenalectomy: Initial Experience by the Same Laparoscopic Surgeon

Abstract

Purpose: The purpose of this study was to demonstrate our initial experience with and the feasibility of laparoendoscopic single-site retroperitoneoscopic adrenalectomy (LESS-RA). Patients and Methods: 54 patients undergoing conventional retroperitoneoscopic adrenalectomy were compared with 27 patients undergoing LESS-RA. The adrenal tumors were considered to be benign preoperatively and <6 cm. Age, sex, laterality, body mass index, surgical indications, time to resuming oral intake, tumor size, operation time, estimated blood loss, intravenous or intramuscular analgesics (pethidine) and postoperative hospital stay were compared between the two groups. Analysis of covariance was applied to analyze postoperative hospital stay and time to resuming oral intake. Results: The length of postoperative hospital stay was significantly higher in the conventional retroperitoneoscopic adrenalectomy group in the adjusted and unadjusted model. The time to resuming oral intake was significant shorter in the LESS-RA group, but was not significant after adjusting opioid analgesics dosage. No conversions to an open or conventional retroperitoneoscopic approach were necessary. There were neither complications nor blood transfusions in both groups. Conclusions: LESS-RA for benign adrenal tumors is a feasible surgical procedure when tumors are <6 cm. Further clinical research is warranted to define the role of LESS in adrenal surgery and to prove its efficacy over conventional laparoscopic surgery.

Efficacy and safety of laparoendoscopic single-site adrenalectomy versus conventional laparoscopic adrenalectomy: an updated systematic review and meta-analysis.

“…All the eighteen studies reported operative time [9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26]. The meta-analysis of these studies showed longer operative time for LESSA (WMD = 13.86 min, 95% CI: 4.43 to 23.30; p = 0.004).…”

“…Overall, eighteen studies including 1307 patients (LESSA 520; CLA 787) were included in this study (Figure 1). Table I shows the basic characteristics and quality assessment of the included studies [9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26].…”

“…EBL data were available in twelve studies including 896 patients (LESSA 331; CLA 565) [9, 11, 13-17, 20, 21, 24-26]. Thirteen studies including 880 patients (LESSA 334; CLA 546) reported transfusion [13,[15][16][17][18][19][20][21][22][23][24][25][26]. Seventeen studies including 1282 patients (LESSA 483; CLA 799) reported conversion [9,10,[12][13][14][15][16][17][18][19][20][21][22][23][24][25][26].…”

Comparison of Transperitoneal and Retroperitoneal Laparoendoscopic Single-site Donor Nephrectomy

“…LESS is a revolutionary laparoscopy because of the advantage of less bleeding, less wound pain, less risk of incisional hernia, and better cosmesis [17]. At our institution, our surgeons experience single-port laparoscopic surgery technique, such as LESS adrenalectomy, herniorrhaphy, partial nephrectomy, and robotic single-port radical prostatectomy in daily practice [18][19][20]. LESS-DN has become the standard procedure for living-donor kidney transplantation since December 2017 in our institution.…”

Laparoendoscopic single-site adrenalectomy versus multi-port laparoendoscopic adrenalectomy: A systemic review and meta-analysis

“…In the past few years, numerous comparative studies have investigated whether LESS-A presents considerable advantages over multi-port laparoendoscopic adrenalectomy (m-LA) or can be an alternative treatment option [ [13] , [14] , [15] , [16] , [17] , [18] , [19] , [20] , [21] , [22] , [23] , [24] , [25] , [26] , [27] , [28] , [29] , [30] , [31] , [32] , [33] , [34] , [35] ]. Three meta-analyses [ [36] , [37] , [38] ] compared the surgical outcomes of LESS-A and m-LA by analyzing approximately 225 cases of LESS-A and 449 cases of m-LA [ [25] , [26] , [27] , [28] , [29] , [30] , [31] , [32] , [33] , [34] , [35] ]. However, the results of the three meta-analyses presented considerable discrepancies in terms of outcomes, including operative time, length of hospital stay, postoperative pain scores, and required analgesic doses.…”