Transumbilical laparoendoscopic single-site adrenalectomy: A feasible and safe alternative to standard laparoscopy

Abstract

Objectives: Standard multi-port laparoscopic adrenalectomy (LA) is considered the gold standard for benign adrenal tumors. Single-site LA has been proposed as a feasible and safe alternative because of lower invasiveness, improved cosmetics, less pain and shorter hospital stay. The objective was to evaluate and compare results of single-site transumbilical laparoendoscopic adrenalectomy with standard LA for adrenal tumors. Materials and methods: One hundred consecutive adrenalectomies from 93 patients, performed between March 2009 and June 2017, were laparoscopically excised: 59 by standard multi-port LA (group 1) and 41 by transumbilical laparoendoscopic single-site adrenalectomy (group 2). Data gathered included demographics, comorbidities, preoperative imaging, tumor characteristics, perioperative data, surgical complications, pathology and follow-up. IBM SPSS Statistics 23 software was used and p value < 0.05 was considered significant. Results: Patients of group 2 were younger (48.7 ± 13.9 versus 59.7 ± 15.1 years; p < 0.001) and had fewer comorbidities (p < 0.05). Mean tumor diameter in group 2 was lower than those of group 1 (27.52 ± 14.3 versus 47.9 ± 30.6 mm; p < 0.001). Tumor laterality did not influence the choice of technique nor the surgical morbidity. All procedures were successfully completed, although one standard LA needed conversion to open surgery. Mean operative time, hemorrhagic losses, postoperative opioid analgesic requirement and hospital stay were not statistically different between groups. Most patients in group 2 (31 patients, 85.4%) did not require drainage, compared to 14 (25.4%) patients of group 1 (p < 0.001). Patients who underwent single-site LA resumed normal diet earlier (1.0 ± 0.2 versus 1.6 ± 0.7 days; p < 0.001). There were no reoperations and no perioperative mortality. Overall mean follow-up time was 94.9 ± 3.1 months, not statiscally different between groups (p = 0.7). Conclusions: Our results revealed that transumbilical approach for laparoendoscopic single-site adrenalectomy for adrenal tumors is a feasible and safe alternative to standard laparoscopic adrenalectomy.

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

“…The sample size of the studies ranged from 22 to 210 patients. A commercially available multichannel port device was used for LESS-A in the majority of the studies [ [13] , [14] , [15] , [19] , [20] , [21] , [24] , [25] , [26] , 28 , 30 , 31 , 33 , 41 ]. Three studies used a single glove or a commercially available multichannel port device [ 22 , 32 , 42 ].…”

“…Results revealed no significant difference in postoperative pain scores between LESS-A and m-LA in the subset analysis. Five studies reported the use of postoperative pain medication [ 13 , 15 , 19 , 30 , 33 ]. Postoperative pain medication was administered to 48.03% patients (73/152 patients) treated with LESS-A, and the percentage was 69.27% (133/192 patients) for those treated with m-LA.…”

“…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. Moreover, these meta-analyses did not include many recent lines of evidence, which remarkably influenced the results [ [14] , [15] , [16] , [17] , [18] , [19] , [20] , [21] , [22] , [23] , [24] ]. To clarify the confusion concerning outcomes, we performed an updated meta-analysis of all available comparative studies to reassess the efficacy, safety, and potential advantages of LESS-A compared with m-LA in the treatment of patients with adrenal tumors.…”

Removal of pediatric stage IV neuroblastoma by robot-assisted laparoscopy: A case report and literature review

“…Traditional open surgery has disadvantages, such as the creation of a large incision, difficulty achieving deep exposure, severe trauma, and a long recovery period. Since the first report of laparoscopic adrenalectomy[20], laparoscopic adrena-lectomy has been frequently reported[21-23]. The application of laparoscopy in NB resection is very extensively reported in the literature; however, if the NB is closely associated with important blood vessels, the use of a laparoscope in NB resection is still challenging and has limitations.…”