Portless endoscopic adrenalectomy via a single minimal incision using a retroperitoneal approach: Experience with initial 30 cases

Abstract

Aim : To assess the feasibility of portless endoscopic adrenalectomy via a single minimum incision that narrowly permits extraction of the specimen. Methods : For 30 cases of adrenal tumor, portless endoscopic surgery through a single flank incision (3-9 cm; mean, 5.6 cm) was performed without gas inflation or trocar port placement. All of the instruments used during surgery were reusable. The cases included primary aldosteronism (12), Cushing's syndrome (6), preclinical Cushing's syndrome (3), pheochromocytoma (1), nonfunctioning cortical adenoma (6), adrenocortical carcinoma (1) and adrenocortical hemorrhage (1). Results : Resection of the tumor was successfully completed, without complications, in all of the cases. Operative time was between 83 and 240 min (mean, 147 min). Estimated blood loss was 5-470 mL (mean, 139 mL). None of the patients required blood transfusion. Postoperative course was uneventful. Wound pain was mild and walking and full oral feeding were resumed on the first and second postoperative day, respectively, in the majority of cases. Conclusions : Adrenal tumors are good candidates for portless endoscopic surgery, which is safe, cost-effective, minimally invasive and matches favorably with laparoscopic surgery.

Single-Incision Retroperitoneoscopic Adrenalectomy and Single-Incision Laparoscopic Adrenalectomy

“…This surgery was performed retroperitoneoscopically in the lateral flank position with the aid of a proctoscope without CO 2 insufflation. Even an incision of 9 cm was reported by Kageyama et al 15 Length of incision never exceeded 2 cm in our study.…”

“…[3][4][5] To date, only case reports and small series on single-incision adrenalectomy have been published. 6,7,[13][14][15] To our knowledge, this study is the first published series about laparoscopic and retroperitoneoscopic single-incision adrenalectomy.…”

Single-port endoscopic retroperitoneal adrenalectomy: initial experience

“…Recent advances in technology and instrumentation coupled with a mastery of laparoscopic surgery have led to single-access procedures being performed in patients with various pathology, including adrenal gland pathology. Endoscopic adrenalectomy through a single incision using a retroperitoneal approach without gas inflation and trocar port placement was first performed by Kageyama et al [7]. Later Hirano in 53 patients performed retroperitoneoscopic adrenalectomy using a rectoscope tube of 4 cm diameter and standard laparoscopic instruments without carbon dioxide insufflation [8].…”

Comparison of radical nephrectomy techniques in one center: Minimal incision portless endoscopic surgery versus laparoscopic surgery

“…A new concept for minimally invasive surgery was established in Japan, termed portless endoscopic surgery (PLES), and adapted for treatment of renal cell carcinoma, 3,4 adrenal tumor, 5 and prostate cancer. 6 But, since not many centers have adapted both techniques, comparisons between PLES-RN and LRN are inadequate.…”