Abstract
Background
Laparoscopic adrenalectomy is the gold standard surgical approach for small benign adrenal tumors [1]. Several surgical approaches were developed in order to overcome the difficulty to access the adrenal glands, located in the upper retroperitoneum space [2,3,4]. Laparoendoscopic single-site posterior retroperitoneoscopic adrenalectomy (LESS-PRA) is an emerging technique that reduced the multiple trocar-related trauma and improved cosmetic outcomes while minimizing postoperative morbidity [5,6,7,8]. The aim of this study was to describe our step-by-step technique for LESS-PRA and to compare our perioperative outcomes with the conventional 3-port lateral retroperitoneoscopic adrenalectomy (LRA).
Methods
A retrospective review was carried out from February 2008 to January 2016 that included 100 patients with adrenal tumors smaller than 4 cm. Study exclusion criteria were defined as tumor size greater than 4 cm, patients older than 80 years, and body mass index (BMI) greater than 40. A total of 20 patients underwent LESS-PRA and 80 patients underwent 3-port lateral retroperitoneoscopic laparoscopic adrenalectomy. Patient’s demographic data and perioperative outcomes were compared and statistically analyzed. The cosmetic satisfaction was evaluated with a visual analog scale.
Results
Estimated blood loss was higher in LRA (100 vs. 50 ml; p = 0.35). Operative time was longer in LESS-PRA than LRA (100.0 vs. 60 min; p < 0.001). Analgesic time necessary for LRA was longer than LESS-PRA (40 vs. 24 h; p < 0.001). Cosmetic satisfaction score was higher in LESS-PRA (9.5 vs. 8.6; p = 0.03). There were no significant differences in perioperative complications and length of hospital stay. No conversion to conventional laparoscopic or open surgery was necessary.
Conclusion
LESS-PRA presented comparable functional and perioperative outcomes to LRA for small adrenal tumors. Although LESS-PRA was associated with longer operative time, it provided inferior estimated blood loss, analgesic time, and improved cosmetic satisfaction.
Article PDF
Similar content being viewed by others
Avoid common mistakes on your manuscript.
References
Smith CD, Weber CJ, Amerson JR (1999) Laparoscopic adrenalectomy: new gold standard. World J Surg 23(4):389–396
Cabalag MS, Mann GB, Gorelik A, Miller JA (2014) Comparison of outcomes after laparoscopic versus posterior retroperitoneoscopic adrenalectomy: a pilot study. Surg Laparosc Endosc Percutan Tech 24(1):62–66
Mysliwiec P, Marek-Safiejko M, Lukaszewicz J et al (2014) Videoscopic adrenalectomy—when does retroperitoneal seem better? Videosurg Miniinv 9(2):226–233
Brandao LF, Autorino R, Laydner H et al (2014) Robotic versus laparoscopic adrenalectomy: a systematic review and meta-analysis. Eur Urol 65(6):1154–1161
Liatsikos E, Kallidonis P, Kyriazis I, Al-Aown A, Stolzenburg JU (2009) Urologic laparoendoscopic single-site surgery. Nat Rev Urol 6(12):654–659
Canes D, Desai MM, Aron M, Haber GP, Goel RK, Stein RJ, Kaouk JH, Gill IS (2008) Transumbilical single-port surgery: evolution and current status. Eur Urol 54(5):1020–1029
Lin VC, Tsai YC, Chung SD, Li TC, Ho CH, Jaw FS, Tai HC, Yu HJ (2012) A comparative study of multiport versus laparoendoscopic single-site adrenalectomy for benign adrenal tumors. Surg Endosc 26(4):1135–1139
Kwak HN, Kim JH, Yun JS, Son BH, Chung WY, Park YL, Park CH (2011) Conventional laparoscopic adrenalectomy versus laparoscopic adrenalectomy through mono port. Surg Laparosc Endosc Percutan Tech 21(6):439–442
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Disclosures
Marcos-Tobias Machado, Igor Nunes-Silva, Eduardo Fernandes da Costa, Alexandre Kyoshi Hidaka, Eliney Ferreira Faria, Hamilton Zampolli and Carlos Alberto Bezerra have no financial interest in any of the products, devices, or drugs mentioned in this manuscript.
Additional information
Marcos-Tobias Machado and Igor Nunes-Silva had the same position as first authors in this paper.
Electronic supplementary material
Below is the link to the electronic supplementary material.
Rights and permissions
About this article
Cite this article
Machado, MT., Nunes-Silva, I., da Costa, E.F. et al. Laparoendoscopic single-site retroperitoneoscopic adrenalectomy: bilateral step-by-step technique. Surg Endosc 31, 3351–3352 (2017). https://doi.org/10.1007/s00464-016-5400-1
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00464-016-5400-1