Laparoendoscopic single-site surgery adrenalectomy - own experience and matched case-control study with standard laparoscopic adrenalectomy.

Abstract

IntroductionAt our institution, laparoendoscopic single-site surgery (LESS) has been established as a technique for laparoscopic nephrectomy since 2011, and since 2012 in selected cases for adrenalectomy (AE) as well.AimTo compare LESS AE with standard laparoscopic AE (SLAE).Material and methodsBetween 3/2012 and 7/2014, 35 adrenalectomies were performed. In 18 (51.4%), a LESS approach was chosen. Indications were strictly non-complicated cases (body mass index (BMI) < 34 kg/m2, tumour ≤ 7 cm, non-malignant aetiology, no previous surgery). All LESS procedures were done by one surgeon. Standard equipment was a 10 mm rigid 0° camera, Triport+, one pre-bent grasper, and a sealing instrument. The approach was pararectal in all cases except one (transumbilical in a slim man). Three patients with LESS were excluded (2 partial AEs only, one adrenal cancer converted to SLAE and then to open surgery). These 15 LESS AE procedures were compared to 15 SLAEs with similar characteristics chosen among 54 SLAEs performed in the period 1/2008–2/2012.ResultsIn 8 cases (53.3%) of LESS AE, a 3 mm port was added to elevate the liver/spleen. Mean parameters of LESS AE vs. SLAE (Wilcoxon test): maximal tumour diameter 43.7 mm vs. 36.1 mm (p = 0.28), time of surgery 63.3 min vs. 55.3 min (p = 0.22), blood loss 38.0 ml vs. 38.0 ml (p = 0.38), BMI 26.9 kg/m2 vs. 28.5 kg/m2 (p = 0.13), discharge from hospital 5.4 days vs. 3.9 days (p = 0.038). There were no complications in either group.ConclusionsThe LESS AE is feasible in selected cases, especially small left-sided tumours in thin patients with no history of previous abdominal operations, but requires an additional port in half of the cases.

Laparoscopic left and right adrenalectomy from an anterior approach - is there any difference? Outcomes in 176 consecutive patients.

“…Some reports describe laparoendoscopic single site (LESS) adrenalectomy as more time consuming compared to the standard laparoscopic procedure [ 17 , 18 ]. The LESS adrenalectomy seems feasible in selected cases, especially small left-sided tumors in thin patients with no history of previous abdominal operations, but may require an additional port in half of the cases [ 19 ]. Robot-assisted adrenalectomy is described to have a shorter hospital stay, less blood loss, and lower occurrence of postoperative complications [ 20 , 21 ].…”

Laparoscopic adrenalectomy for pheochromocytoma is more difficult compared to other adrenal tumors.

“…Twenty-two years have passed since the first report on laparoscopic adrenalectomy was published [ 16 ]. Nowadays, minimally invasive surgery in cases of benign adrenal tumors has become a safe method that gives good results [ 6 – 8 , 17 , 18 ]. However, there is a continuous discussion concerning cases of pheochromocytoma, which can be a challenge to both the surgeon and the anesthetist.…”

Right adrenal gland pseudocyst masquerading as a large symptomatic hepatic cyst: Single incision laparoscopic (SILS) resection and a review of current literature

“…Since the first laparoscopic adrenalectomy by Gagner et al 12 in 1992, in well selected patients, laparoscopic surgery was shown to reduce blood loss, decrease length of stay with quicker commencement of oral intake and return of bowel function. 13 14 15 Single-incision laparoscopic surgery for the adrenal gland, performed either via a retroperitoneoscopic or transabdominal approach, has been gaining popularity, 16 17 18 19 20 with similar outcomes as those of conventional laparoscopic surgery, in addition to improved cosmesis. 16 Ishida et al 20 demonstrated that despite the feasibility of single-incision transumbilical laparoscopic adrenal surgery, there were obvious technical difficulties compared to conventional laparoscopy.…”

“… 16 Ishida et al 20 demonstrated that despite the feasibility of single-incision transumbilical laparoscopic adrenal surgery, there were obvious technical difficulties compared to conventional laparoscopy. Hora et al 17 performed single incision laparoscopic adrenalectomies strictly on small tumors with a non-malignant etiology, in their series of 18 cases. In our patient, despite adequate positioning, she had a large floppy liver which was partially obscuring the surgical field.…”