Technical difficulties of transumbilical laparoendoscopic single-site adrenalectomy: comparison with conventional laparoscopic adrenalectomy

Abstract

Interest in laparoendoscopic single-site (LESS) surgery has increased in recent years. The aim of this study was to evaluate the feasibility and safety of transumbilical LESS adrenalectomy and to elucidate the technical differences between LESS and conventional laparoscopic surgery. This study was comparing 10 consecutive transumbilical LESS adrenalectomies and 10 conventional laparoscopic adrenalectomies performed between March 2006 and April 2010 for benign adrenal tumors. Perioperative parameters were compared, and we reviewed our surgical videos and analyzed technical characteristics of the surgeries. There was no open conversion in laparoscopic group, no additional port placement in LESS group, and no perioperative complications in either group. No significant differences in operative time, estimated blood loss, or resumption of oral intake were observed between two groups. Pneumoperitoneum time did not differ between LESS and laparoscopic groups (91.2 vs. 74.3min, P=0.257). In LESS group only, time was needed for adjustment of roticulator (14.5±8.1min). After subtracting the time needed for adjustment, operative time between two groups was more comparable (76.7 vs. 74.3min, P=0.880). One-handed manipulation time in LESS group decreased in a time-dependent manner (r=-0.806, P<0.0049). Tissue re-grasping during operation was more frequently observed in LESS group (16.2 vs. 2.2 times, P<0.001). Transumbilical LESS adrenalectomy is feasible and comparable to conventional laparoscopic adrenalectomy. There are still obvious technical difficulties associated with LESS surgery, and it is essential that these be overcome in order to improve this surgical technique.