Laparoendoscopic Single-site Adrenalectomy Research Articles

396 Laparoendoscopic single-site adrenalectomy by using internal organ retractor system: Initial comparative study

396 Laparoendoscopic single-site adrenalectomy by using internal organ retractor system: Initial comparative study

V4-08 LAPAROENDOSCOPIC SINGLE-SITE (LESS) ADRENALECTOMY IN MORBIDLY OBESE PATIENT WITH CUSHING SYNDROME

You have accessJournal of UrologyAdrenal/Robotics1 Apr 2014V4-08 LAPAROENDOSCOPIC SINGLE-SITE (LESS) ADRENALECTOMY IN MORBIDLY OBESE PATIENT WITH CUSHING SYNDROME Aly Abdel-Karim, Elsaid Yehia, and Salah Elsalmy Aly Abdel-KarimAly Abdel-Karim More articles by this author , Elsaid YehiaElsaid Yehia More articles by this author , and Salah ElsalmySalah Elsalmy More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.1541AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail Introduction and Objectives LESS has been described as an alternative minimally invasive treatment option for different urologic pathologies. However, LESS is still has limitations with strict patients selection criteria. We present LESS adrenalectomy for a morbidly obese patient with Cushing syndrome and relatively large left adrenal mass. Methods We present 32 years old female patient who was diagnosed clinically, biochemically and radiologically as Cushing syndrome. Computed tomography (CT) of the abdomen and pelvis showed 6.6 X 5.8 X 4.5 cm left adrenal tumor. BMI of the patient was 42. While the patient in the modified flank position, LESS left adrenalectomy was done using Covedien port that as placed at the umbilicus through 2.5- cm skin incision. During LESS adrenalectomy we used both articulating and straight instruments as well as 5-mm EndoEye camera. Dissection started by medial reflection of the left descending colon. The left adrenal vein was identified and clipped and en-bloc dissection of the adrenal gland and the tumor was done using both blunt and sharp dissection. Finally the gland was retrieved in an Endo-bag through the port site. Results The operative time was 180 minutes. Blood loss was 200 c.c and there was no blood transfusion. There was no conversion to open surgery or conventional laparoscopy. No extra-port was added. There were no intraoperative or postoperative complications. The postoperative umbilical incision after retrieval of the tumor was 3.5 cm. Hospital stay was 3 days. Visual Analogue Pain Scale at discharge was 2. The patient required only non-steroidal anti-inflammatory as postoperative analgesics. Histopathology confirmed the diagnosis of adrenal cortical adenoma. Conclusions LESS adrenalecomy is feasible and safe option for morbidly obese patients with Cushing syndrome. Although technically difficult, the procedure has low morbidity and high patient satisfaction. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e553 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Aly Abdel-Karim More articles by this author Elsaid Yehia More articles by this author Salah Elsalmy More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Patient-reported satisfaction and cosmesis outcomes following laparoscopic adrenalectomy: laparoendoscopic single-site adrenalectomy vs. conventional laparoscopic adrenalectomy

We evaluate patient-reported satisfaction and cosmesis of laparoendoscopic single-site adrenalectomy (LESS-A) in comparison with that of conventional laparoscopic adrenalectomy (CLA). A total of 19 and 104 patients who respectively underwent LESS-A and CLA between May 1996 and June 2011 were included in the study. Questionnaires inquiring about scar pain (0: not painful, 10: very painful), satisfaction (0: not satisfied, 10: very satisfied) and cosmesis (0: very unsightly, 10: very beautiful) on the basis of a visual analogue scale were sent to patients postoperatively. The respondents consisted of 11 and 54 patients who underwent LESS-A and CLA, respectively. There was no significant inter-group difference in age, sex, affected side or body mass index. No significant differences were observed in operative time or estimated blood loss. There were also no significant differences in pain (0.67 vs. 0.57, p = 0.393), satisfaction (8.92 vs. 8.46, p = 0.453), or cosmesis score (8.58 vs. 8.00, p = 0.487) between the LESS-A and CLA groups overall. In female patients, the satisfaction score was significantly higher in the LESS-A group than in the CLA group (10.0 vs. 8.72, p = 0.049). In young patients (<50 years old), the satisfaction score was also significantly higher in the LESS-A group than in the CLA group (9.17 vs. 6.38, p = 0.036). Young patients and female patients who had received LESS-A adrenal surgery were more satisfied with the scar outcomes than were the young patients and female patients who had received CLA. We suggest that this patient subset most values the cosmetic benefits of LESS-A.

Retroperitoneal Laparoendoscopic Single-Site Adrenalectomy for Pheochromocytoma: Our Single Center Experiences

To evaluate the feasibility and safety of retroperitoneal laparoendoscopic single-site adrenalectomy for pheochromocytoma (LESS-PHEO) and summarize our initial experience. Between June 2009 and June 2013, 21 patients with adrenal pheochromocytoma underwent adrenalectomy by means of LESS-PHEO in our department. Fifty-three patients with pheochromocytoma underwent conventional retrolaparoscopic adrenalectomy (RLAP-PHEO) between March 2001 and June 2013, of whom 42 were selected as a control group for a retrospective serial case-control analysis (1:2 matched-pair cohort). In the operation, the retroperitoneal space was created and dilated by blunt finger dissection and the pneumoperitoneal pressure was maintained below 10 mm Hg. As the first step, ligation of the adrenal central vein was performed. Intraoperative hemodynamic parameters, operating time, estimated blood loss, transfusion requirement, incidence of perioperative complications, visual analog pain scale (VAPS) score, time to resumption of oral intake and ambulation, and postoperative hospitalization were compared between the groups. All the operations were technically successful, without reoperations or conversion to open procedures. The 24-hour postoperative VAPS score was lower in the LESS-PHEO group than in the control group (5 vs 7; p<0.001). Despite a longer median operative time (167.4 minutes vs 125.5 minutes; p<0.001), the patients in the LESS-PHEO group resumed oral intake sooner (1 day vs 2 days; p<0.001), ambulated sooner (1 day vs 2 days; p<0.001), and were discharged earlier (4 days vs 7 days; p<0.001). No perioperative complications occurred in both the groups. No statistically significant differences in hemodynamic parameters or estimated blood loss were found between the groups. Although more training and practice are needed to shorten its operative time, LESS-PHEO, as performed by an experienced laparoscopic urologist, is a feasible and safe procedure associated with less postoperative pain and faster recovery.

Visceral Fat Is Correlated With Prolonged Operative Time in Laparoendoscopic Single-site Adrenalectomy and Laparoscopic Adrenalectomy

To investigate the effect of visceral fat on operative time and discuss whether the measurement of adipose accumulation could be used as a sensitive predictor of technical difficulty in performing laparoendoscopic single-site adrenalectomy (LESS-A) and laparoscopic adrenalectomy (LA). We reviewed the medical records of 106 patients undergoing LA or LESS-A at our institution. Total fat area (TFA) and visceral fat area (VFA) were measured at the level of the L4 vertebra by computed tomography. To categorize the type of obesity, the VFA/TFA ratio was calculated. Multiple logistic regression analyses were performed to identify independent predictors of prolonged operative time. The VFA/TFA ratio does not always coincide with body mass index (BMI, r = 0.415), and a higher correlation coefficient was observed between operative time and the VFA/TFA ratio (r = 0.359) than with that of BMI (r = 0.189). Multivariate analysis revealed that pheochromocytoma, tumor size ≥ 5 cm, and the VFA/TFA ratio ≥ 0.35, defined as the visceral type of adipose accumulation, were independent predictive factors for prolonged operative time in LA and LESS-A. We were able to stratify patients into short, intermediate, and long operative times using these preoperative variables. This study revealed that the visceral type of adipose accumulation increases operative complexity in LA and LESS-A as measured by operative time. The VFA/TFA ratio might be a more sensitive indicator of technical difficulty than that of BMI.

Laparoendoscopic Single-Site Adrenalectomy Versus Conventional Laparoscopic Surgery: A Systematic Review and Meta-Analysis of Observational Studies

To assess the surgical efficacy and potential advantages of laparoendoscopic single-site adrenalectomy (LESS-AD) compared with conventional laparoscopic adrenalectomy (CL-AD) based on published literature. An online systematic search in electronic databasesM including Pubmed, Embase, and the Cochrane Library, as well as manual bibliography searches were performed. All studies that compared LESS-AD with CL-AD were included. The outcome measures were the patient demographics, tumor size, blood loss, operative time, time to resumption of oral intake, hospital stay, postoperative pain, cosmesis satisfaction score, rates of complication, conversion, and transfusion. A meta-analysis of the results was conducted. A total of 443 patients were included: 171 patients in the LESS-AD group and 272 patients in the CL-AD group (nine studies). There was no significant difference between the two groups in any of the demographic parameters expect for lesion size (age: P=0.24; sex: P=0.35; body mass index: P=0.79; laterality: P=0.76; size: P=0.002). There was no significant difference in estimated blood loss, time to oral intake resumption, and length of stay between the two groups. The LESS-AD patients had a significantly lower postoperative visual analog pain score compared with the CL-AD group, but a longer operative time was noted. Both groups had a comparable cosmetic satisfaction score. The two groups had a comparable rate of complication, conversion, and transfusion. In early experience, LESS-AD appears to be a safe and feasible alternative to its conventional laparoscopic counterpart with decreased postoperative pain noted, albeit with a longer operative time. As a promising and emerging minimally invasive technique, however, the current evidence has not verified other potential advantages (ie, cosmesis, recovery time, convalescence, port-related complications, etc.) of LESS-AD.

Laparoendoscopic single site adrenalectomy: initial results of cosmetic satisfaction and the potential for postoperative pain reduction

BackgroundRecent reports have suggested that laparoendoscopic single site (LESS) surgery is technically feasible. The aim of this study was to describe our initial experience with LESS adrenalectomy for benign adrenal tumors, focusing the attention about cosmetic satisfaction and reduction of postoperative pain.MethodsMedical records of consecutive patients undergoing LESS adrenalectomy were analyzed. All procedures were performed through a single multichannel port. Demographic and operative data were assessed. A visual analog scale (VAS) was used with a 10-point scale for an objective assessment of incisional pain and incisional cosmesis.ResultsBetween January 2010 and July 2012, 14 consecutive patients with benign adrenal tumors underwent LESS adrenalectomies. Of the planned LESS adrenalectomies, 12 (86%) were completed with a single-port, whereas two required an additional port placement. Mean operating time was 128.1 ± 31.5 min and mean blood loss 10.5 ± 12.1 ml. Mean pain scores using the VAS on postoperative days 1, 3, and 14 were 2.3, 1.0, and 0.3 points, respectively. The rate of analgesic use was also lower within 12 hours after surgery (14%). The patient was highly satisfied with the single small wound procedure, and mean cosmesis scores of postoperative days 3 and 14 were 9.4 and 9.8 points, respectively. The postoperative course was uneventful with no morbidity within one month of follow-up.ConclusionsLESS adrenalectomy is a safe and technically feasible procedure for patients with benign adrenal tumors, and offers cosmetic benefit and the potential for postoperative pain reduction. However, surgeons with lack of experience as LESS surgery should be comprehended that the assistance of the needlescopic instrument does not compromise the cosmetic outcomes for difficult cases and the obese patients may not always be suitable candidates for pure LESS technique.

A Systematic Review and Meta-Analysis of Current Evidence Comparing Laparoendoscopic Single-Site Adrenalectomy and Conventional Laparoscopic Adrenalectomy

To assess the efficacy and safety of laparoendoscopic single-site adrenalectomy (LESS-A) and conventional laparoscopic adrenalectomy (LA) as a systematic review and meta-analysis of current evidence. We conducted a thorough search for comparative studies that compared LESS-A and conventional LA in the following databases: MEDLINE, EMBASE, and the Cochrane library. Studies were reviewed independently and rated by Newcastle-Ottawa Quality Assessment Scale. The operative time, estimated blood loss in operation, the time to resume oral intake after surgery, postoperative hospital stay, and the visual analog pain scale (VAPS) score were included for analysis to compare the efficacy, while the complications together with the analgesia use were included for analysis to compare the safety. Nine studies with 171 LESS-A cases and 272 conventional LA cases were identified. Although operative time was longer in LESS-A (mean difference [MD] 15.46, 95% confidence interval [CI] 11.18 to 19.74), estimated blood loss (MD 4.72, 95% CI 12.08 to 21.52) and the time to resume oral intake (MD -0.04, 95% CI -0.19 to 0.11) were similar; LESS-A presented a shorter postoperative stay in hospital (MD -0.60, 95% CI -0.86 to -0.35) and lower VAPS score (MD -1.21, 95% CI -1.44 to -0.97). Besides, the risk of minor postoperative complications (risk ratio [RR] 1.74, 95% CI 0.78 to 3.87) was similar. The postoperative analgesia demand in total (RR 0.65, 95% CI 0.52 to 0.81) together with the analgesia usage lasting more than 24 hours after surgery (RR 0.35, 95% CI 0.21 to 0.58) were associated with lower risk in LESS-A, however. Based on current evidence, the operative time seems to be longer in LESS-A; however, operative blood loss and complications are similar. In addition, LESS-A presents a shorter hospital stay after surgery and more acceptable perception of pain than conventional LA.

51 LAPAROSCOPIC ADRENALECTOMY INCLUDING LESS IN PATIENTS WITH PHEOCHROMOCYTOMA: THE EVALUATION OF PERIOPERATIVE SURGICAL RISK

You have accessJournal of UrologyAdrenal1 Apr 201351 LAPAROSCOPIC ADRENALECTOMY INCLUDING LESS IN PATIENTS WITH PHEOCHROMOCYTOMA: THE EVALUATION OF PERIOPERATIVE SURGICAL RISK Seiya Hattori, Akira Miyajima, Takahiro Maeda, Toshikazu Takeda, Eiji Kikuchi, Ken Nakagawa, and Mototsugu Oya Seiya HattoriSeiya Hattori Tokyo, Japan More articles by this author , Akira MiyajimaAkira Miyajima Tokyo, Japan More articles by this author , Takahiro MaedaTakahiro Maeda Tokyo, Japan More articles by this author , Toshikazu TakedaToshikazu Takeda Tokyo, Japan More articles by this author , Eiji KikuchiEiji Kikuchi Tokyo, Japan More articles by this author , Ken NakagawaKen Nakagawa Tokyo, Japan More articles by this author , and Mototsugu OyaMototsugu Oya Tokyo, Japan More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.1427AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Laparoendoscopic single-site adrenalectomy (LESS-A) has been developed as a treatment option for adrenal tumors that has cosmetic benefit and less postoperative pain. Some reports proposed that patient selection criteria should be stringent, and pheochromocytoma (PHE) should be taken as advanced indication. Here, we examined the perioperative outcomes of PHE patients who underwent laparoscopic adrenalectomy (LA), while paying special attention to any differences in surgical techniques. METHODS The records of a total of 233 consecutive patients who underwent LA at our hospital from May 2001 to February 2012 were entered into a database. Surgical procedures were performed by two experienced laparoscopic surgeons. 1) 50 patients who underwent LA for PHE (group PHE, n=50) were compared with patients who underwent LA for other benign adrenal tumors (group non-PHE, n=183). 2) 20 consecutive patients with PHE who underwent LESS-A were compared with patients with PHE who underwent conventional LA (c-LA, n=30). RESULTS 1) Each group was equivalent with respect to age, sex, BMI, tumor side, perioperativeíícomplication rate, and intraoperative bleeding. There were significant differences in mean size (non-PHE/PHE: 22.8±14.8 mm/46.0±21.9 mm, p<0.001) and mean pneumoperitoneum time (non-PHE/PHE: 85.3±33.0 mm/123.7±55.1 min, p<0.001) between the two groups. At least one postoperative complication (Clavien-Grade≥2) occurred in 13 patients (non-PHE/PHE: 10 cases/3 cases). 2) Each group was statistically equivalent with respect to age, BMI, tumor size, operative time, intraoperative bleeding, and postoperative hospital stay. There were no significant differences in preoperative hemodynamic variables between the two groups. There were no significant differences in the highest intraoperative blood pressure (LESS-A/c-LA: 161.7±7.8 mmHg/180.6±7.4 mmHg, p=0.096), hypertensive episodes (LESS-A/c-LA: 10 cases/23 cases, p=0.051), or intraoperative hypotensive episodes (LESS-A/c-LA: 4 cases/9 cases, p=0.557). In one case of LESS-A, two additional ports were added. There were 3 perioperative complications (LESS-A/c-LA: 2 cases/1 case, p=0.331). CONCLUSIONS LA was safely performed in patients with PHE compared with that of non-PHE patients. We concluded the safety of LESS-A for PHE as being similar to that of LA. With appropriate pre- and intra-operative hemodynamic control and experienced hands, LESS-A could become one of the treatments of choice for resection of PHE. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e21 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Seiya Hattori Tokyo, Japan More articles by this author Akira Miyajima Tokyo, Japan More articles by this author Takahiro Maeda Tokyo, Japan More articles by this author Toshikazu Takeda Tokyo, Japan More articles by this author Eiji Kikuchi Tokyo, Japan More articles by this author Ken Nakagawa Tokyo, Japan More articles by this author Mototsugu Oya Tokyo, Japan More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Risk Factors for Perioperative Complications of Laparoscopic Adrenalectomy Including Single-Site Surgery

To determine predictive factors for perioperative complications of laparoscopic adrenalectomy (LA) including single-site surgery performed or supervised by experienced laparoscopic surgeons. We retrospectively reviewed 265 consecutive unilateral LAs performed at a single institution from 2001 to 2011. All surgical procedures were performed or supervised by one of two experienced laparoscopic surgeons. The transabdominal approach was used in 248 patients, while a retroperitoneal approach was used in 17 patients. Laparoendoscopic single-site adrenalectomy was performed in 58 patients. Predictive factors for postoperative complications were analyzed. There were no postoperative deaths. At least one postoperative complication occurred in 12 (4.6%) patients. No patient underwent reoperation for a complication. Only one (0.4%) patient's procedure was converted to open surgery, and only this patient needed a blood transfusion during the operation. One patient who underwent laparoendoscopic single-site adrenalectomy had the procedure converted to conventional laparoscopic adrenalectomy. Multivariable logistic regression analysis showed that an American Society of Anesthesiologists-physical status grade 3 or above was the only predictive factor for perioperative complications. American Society of Anesthesiologists-physical status grade 3 or above was a statistically significant factor for perioperative complications associated with laparoscopic adrenalectomy that involved laparoendoscopic single-site adrenalectomy, which was performed or supervised by an experienced laparoscopic surgeon. According to the findings of this retrospective study, single-site operation, obesity, adrenal tumor size, and tumor type may not be considered as risk factors for perioperative complications after LA performed or supervised by an experienced laparoscopic surgeon.

Does laparoendoscopic single-site adrenalectomy increase surgical risk in patients with pheochromocytoma?

LESS (laparoendoscopic single-site) surgery has been developed as a treatment option for adrenal tumors that has less postoperative pain and greater cosmetic benefits. Some reports proposed that patient selection criteria should be stringent, and pheochromocytoma (PHE) should be taken as an advanced indication. The aim of this study is to compare LESS adrenalectomy (ADX) with conventional adrenalectomy (CL-ADX) in patients with PHE, with attention paid not only to immediate postoperative outcomes but also to the intraoperative hemodynamic changes that occur with each technique. The records of 265 consecutive patients who underwent laparoscopic ADX at Keio University Hospital in Tokyo from January 2001 to June 2011 were entered into a database. Surgical procedures were performed or supervised by two experienced laparoscopic surgeons, who performed more than 100 cases of urologic laparoscopic surgery in 2011. Twenty consecutive patients who underwent LESS-ADX from December 2009 to October 2011 were compared with patients who underwent CL-ADX (controls, n = 30) to look at differences in hemodynamic parameters and surgical outcomes in a case-control analysis. Each group was equivalent with respect to age, sex, and BMI. The mean size of 50 PHE was 45.1 ± 4.0 mm, the mean operative time was 151.8 ± 10.6 min, and there was no significant difference between the two groups. In one case of LESS-ADX, two additional ports were added. There was no significant difference between the CL-ADX and LESS-ADX groups in terms of operation time, total fluid during the operation, estimated blood loss, first oral feeding, postoperative stay in the intensive care unit, or postoperative hospital stay. We consider the safety of LESS-ADX of PHE as similar to that of CL-ADX. With appropriate pre- and intraoperative hemodynamic control and experienced hands, LESS-ADX could become one of the treatments of choice for resection of PHE.

Retroperitoneal Laparoendoscopic Single-Site Adrenalectomy: Our Initial Technical Experience

We performed retroperitoneal laparoendoscopic single-site (LESS) adrenalectomy using a homemade multi-access platform to evaluate the feasibility and safety of this technique and to share our initial experiences. Since March 2011, 40 patients underwent retroperitoneal LESS adrenalectomy. A single incision of 2.5-3 cm was made under the 12th rib on the midaxillary line on the affected side. Next, a homemade multi-access platform was inserted through that incision, and a combination of lengthened curved and conventional rigid instruments was used for handling. The procedure was performed mainly according to the procedure for conventional laparoscopic retroperitoneal adrenalectomy. For 1 patient with pheochromocytoma, one additional trocar was used because the peritoneum was damaged. Surgery was successfully completed in all other patients without conversion to conventional laparoscopic or open surgery. Retroperitoneal LESS adrenalectomy is feasible; although initial technical adjustments are inevitable, some useful techniques are effective in simplifying the procedure.

Comparison of Single-surgeon Series of Transperitoneal Laparoendoscopic Single-site Surgery and Standard Laparoscopic Adrenalectomy

To assess the feasibility, safety, and efficacy of transperitoneal laparoendoscopic single-site (LESS) adrenalectomy and determine whether it shows any objective advantage compared with standard laparoscopy. From August 2009 to May 2011, 13 transperitoneal LESS adrenalectomies were performed through a 2-3-cm skin incision using the TriPort access system. This cohort was compared with a contemporary 1:2 matched-pair group of 26 patients undergoing standard laparoscopic adrenalectomy by the same urologist. The perioperative outcomes, including cosmetic satisfaction scores, were statistically analyzed. The 2 groups were comparable with respect to patient demographics, estimated blood loss, and postoperative hospitalization (P > .05). The LESS procedures had a longer mean operative time (148.5 vs 112.9 minutes, P = .032) but a significantly lower postoperative visual analog pain scale score (2.3 vs 3.7, P = .001), fewer patients requiring analgesics (30.8% vs 73.1%, P = .011), and an earlier resumption of oral intake (21.6 vs 26.0 hours, P = .002). The mean length of the scar in the LESS group was much smaller (2.3 vs 5.9 cm, P < .0001) with a statistically significant greater mean cosmetic satisfaction score (9.5 vs 9.1, P = .042). The perioperative outcomes of transperitoneal LESS adrenalectomy for small adrenal tumors were comparable to those with the standard laparoscopic approach. It also provides better postoperative pain control, faster recovery of bowel function, and better cosmetic satisfaction than standard laparoscopy, albeit with a longer operative time.

Reply

We appreciate the comments regarding our work determining the advantages of laparoendoscopic single-site (LESS) adrenalectomy compared with standard laparoscopy. Truly, this modified style in our field has been steadily gaining momentum during the past 3-4 years.1 LESS is not generated de novo; rather, it is developed by applying the techniques and standards developed for standard laparoscopic surgery to the LESS environment. Since the first case of true LESS (transumbilical simple nephrectomy) performed at our institution in 2008, > 150 LESS cases have been performed by the single urologist, covering the major spectrum of urologic laparoscopic indications.

1109 Does laparoendoscopic single-site adrenalectomy in patients with unilateral pheochromocytoma increase surgical risk? A case control study

1109 Does laparoendoscopic single-site adrenalectomy in patients with unilateral pheochromocytoma increase surgical risk? A case control study

Transumbilical approach for laparo‐endoscopic single‐site adrenalectomy: Initial experience and short‐term outcome

To report our initial experience with transumbilical laparo-endoscopic single-site adrenalectomy for adrenal tumors by using a single port with a multichannel cannula and bent laparoscopic instrumentation. Between December 2009 and December 2010, 30 patients underwent transumbilical laparo-endoscopic single-site adrenalectomy at our hospital. The procedure was carried out for adrenal cortical adenoma in 17 patients, adrenal pheochromocytoma in seven patients and other types of tumors in six patients. A multichannel port, bent laparoscopic instruments and Opti4 laparoscopic electrodes were used in all patients. The intraperitoneal space was approached through the umbilicus. The multichannel port was placed through a 2-cm incision at the inner edge of the umbilicus. A 5-mm flexible laparoscope was introduced to maintain an adequate laparoscopic view, and surgical specimens were extracted using an Endocatch bag. All procedures were successfully completed, with only one incision through the umbilicus, and without conversion to a standard laparoscopic approach. Mean operative time was 120.1 ± 34.7 min. Tumor laterality and patient body mass index did not affect surgical morbidity. The initial 15 patients had a significantly longer mean pneumoperitoneum time (95.8 ± 37.5 min) than the last 15 patients (70.5 ± 18.7 min). Only one postoperative complication was observed (postoperative hematoma). A transumbilical approach for laparo-endoscopic single-site adrenalectomy is safe and feasible, and it results in superior cosmesis. Improvements in surgical devices might facilitate further development of this approach.

A comparative study of multiport versus laparoendoscopic single-site adrenalectomy for benign adrenal tumors

The safety and feasibility of laparoendoscopic single-site (LESS) adrenalectomy for benign adrenal lesions was proved in early clinical series. However, the advantages of LESS over multiport laparoscopic adrenalectomy still are under investigation. Since October 2009, the authors have prospectively performed LESS retroperitoneal adrenalectomy for 21 consecutive patients with benign adrenal tumors (LESS group). Another 28 patients with benign adrenal tumors were prospectively collected between June 2006 and October 2009 and served as a multiport laparoscopic adrenalectomy group. The patients' demographic data, operating time, estimated blood loss, peri- and postoperative complications, and short-term outcome were collected for further analysis. The demographic data were comparable between the two groups in terms of the patient age, gender, body mass index (BMI), laterality, diagnosis, and resected specimen weight. No major complication or mortality occurred in either group. Neither group had any conversions. No differences were observed between the two groups in terms of intraoperative hemodynamic status or peri- or postoperative complications. The LESS patients had quicker resumption of oral intake (0.18 vs 1 day; p < 0.001), a shorter hospital stay (2 vs 4 days; p < 0.001), and a reduced analgesic requirement postoperatively (0 vs 0.84 mg/kg; p = 0.023) than the multiport laparoscopic patients. The results demonstrate that LESS adrenalectomy is as safe and effective as conventional multiport laparoscopic adrenalectomy for benign adrenal tumors. In addition, LESS adrenalectomy provides short-term convalescence advantages over multiport laparoscopic adrenalectomy.

Extrapancreatic solid pseudopapillary tumor: case report and review of the literature

A 22-year-old woman complained of abdominal discomfort. Ultrasonography, computed tomography, and an endocrinologic work-up revealed a 7-cm nonfunctional tumor at the left adrenal lesion. A transumbilical laparo-endoscopic single-site adrenalectomy was successfully completed in 166 min. The postoperative period was uneventful. The pathologic examination confirmed the solid pseudopapillary tumor occurred in the retroperitoneum. There are only five previous reports of extrapancreatic solid pseudopapillary tumors. In this case, the tumor was separated from the pancreas and no ectopic pancreas was histologically observed. To the best of our knowledge, this case is the first report of a solid pseudopapillary tumor of the retroperitoneum.

Laparoendoscopic single site (LESS) adrenalectomy: Technique and outcomes

To describe the surgical technique, to analyze outcomes and to provide an overview of the current status of laparoendoscopic single site (LESS) adrenalectomy. A comprehensive PubMed search was performed for all relevant urological literature regarding LESS and adrenal surgery. In addition, experience gained at the authors' own institutions was considered. Clinical descriptive and comparative reports on LESS adrenal surgery procedures were analysed. LESS adrenal surgery has been effectively performed for a number of indications. A wide variety of approaches (transperitoneal versus retroperitoneal, multichannel trocar versus multiple ports, trans- or extraumbilical) have been described. LESS adrenalectomy seems to be safe, taking more time than the standard laparoscopic counterpart but appears to offer the patient less postoperative discomfort. Technical difficulties of the procedure include the requirement of more time for adjustment of articulating instruments, longer 'one-handed' manipulation time, and a high peroperative tissue re-grasping rate. The feasibility and safety of LESS adrenalectomy has been demonstrated. Only long-term follow-up outcomes will prove its benefits over conventional laparoscopy and define the role and the oncological safety of LESS adrenal surgery.

1211 DOES LAPAROENDOSCOPIC SINGLE-SITE ADRENALECTOMY INCREASE SURGICAL RISK IN PATIENTS WITH UNILATERAL PHEOCHROMOCYTOMA?; CASE CONTROL STUDY

You have accessJournal of UrologyTechnology & Instruments: Robotics/Laparoscopy1 Apr 20111211 DOES LAPAROENDOSCOPIC SINGLE-SITE ADRENALECTOMY INCREASE SURGICAL RISK IN PATIENTS WITH UNILATERAL PHEOCHROMOCYTOMA?; CASE CONTROL STUDY Takahiro Maeda, Akira Miyajima, Eiji Kikuchi, Masanori Hasegawa, Takeo Kosaka, Ken Nakagawa, and Mototsugu Oya Takahiro MaedaTakahiro Maeda Tokyo, Japan More articles by this author , Akira MiyajimaAkira Miyajima Tokyo, Japan More articles by this author , Eiji KikuchiEiji Kikuchi Tokyo, Japan More articles by this author , Masanori HasegawaMasanori Hasegawa Tokyo, Japan More articles by this author , Takeo KosakaTakeo Kosaka Tokyo, Japan More articles by this author , Ken NakagawaKen Nakagawa Tokyo, Japan More articles by this author , and Mototsugu OyaMototsugu Oya Tokyo, Japan More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.867AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES We examined the safety of laparoendoscopic single-site adrenalectomy (LESS-A) for pheochromocytoma (PHE) and the benefits of LESS-A over conventional laparoscopic adrenalectomy (CL-A) in patients with PHE. METHODS We identified 92 and 35 consecutive patients who had been treated with CL-A and LESS-A between 2006 and 2010 at our institution. First, we evaluated the 35 consecutive patients in the LESS-A group, which included 10 cases of PHE, and compared the perioperative data and immediate surgical outcomes between the LESS-PHE and non-PHE patients. Next, from this cohort, we selected patients with PHE who underwent both LESS-A (cases, n=10) and CL-A (controls, n=10) in order to conduct a matched case-control study to compare hemodynamic parameters and surgical outcomes. The 10 control patients were matched to the LESS cases with respect to sex, age, body mass index, tumor laterality and size, and the level of preoperative catecholamines. RESULTS Significant differences between LESS-A for PHE and non-PHE in terms of tumor size 36.6±4.7 versus 22.2±3.2 mm (p=0.007), operative time 156.1±12.7 versus 129.0±6.2 minutes (p=0.043), and intraoperative total fluids 2571±208 versus 1389±93 ml (p=0.001) were observed. However, the estimated blood loss, number of days to first postoperative oral feeding, and postoperative hospital stay were similar between the two groups. One of the 10 LESS-A for PHE patients required conversion to CL-A due to stiff adhesions, however, there were no significant differences in operation time, estimated blood loss, or postoperative recovery during the operation in patients with PHE between the CL-A and LESS-A groups. There was no significant difference in the highest intraoperative blood pressure (180.7±8.4 in CL group versus 162.7±8.3 mmHg in LESS group, p=0.149). The frequency of hypertensive episodes, including SBP ≥200 mmHg or ≥30% above the baseline, was not significantly different (7 cases in CL versus 5 cases in LESS). Seven patients in the LESS-group experienced intraoperative hypotension (SBP <80 mmHg), which was similar to the 6 patients in the CL-group. Neither the highest nor lowest heart rate was different between these two groups. There were no treatment-resistant hemodynamic changes that resulted in any serious consequences. CONCLUSIONS We conclude the safety of LESS-A for PHE is comparative with that of CL-A. With appropriate preoperative and intraoperative hemodynamic control together with an experienced surgeon, LESS-A should be considered a treatment choice for resection of PHE. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e486 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Takahiro Maeda Tokyo, Japan More articles by this author Akira Miyajima Tokyo, Japan More articles by this author Eiji Kikuchi Tokyo, Japan More articles by this author Masanori Hasegawa Tokyo, Japan More articles by this author Takeo Kosaka Tokyo, Japan More articles by this author Ken Nakagawa Tokyo, Japan More articles by this author Mototsugu Oya Tokyo, Japan More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...