Article

Transumbilical laparo-endoscopic single site surgery for adrenal cortical adenoma inducing primary aldosteronism: Initial experience

Keio University School of Medicine, Department of Urology, 35 Shinanomachi, Shinjuku, Tokyo 160-8582, Japan. .
BMC Research Notes 09/2011; 4(1):364. DOI: 10.1186/1756-0500-4-364
Source: PubMed

ABSTRACT

ABSTRACT:
We have started using laparo-endoscopic single-site surgery (LESS) in urologic surgery, although its use has not gained momentum due to its level of difficulty. We here report our initial experience with transumbilical LESS for adrenal cortical adenoma by using a single port with a multichannel cannula (SILS port) and bent laparoscopic instrumentation.
A multichannel port (SILS port), bent laparoscopic instrument (Roticulator Endo Mini-Shears) and Opti4 laparoscopic electrodes were used in all cases. The intraperitoneal space was approached through the umbilicus. The SILS port was placed through a 2 cm incision at the inner edge of the umbilicus. A 5 mm flexible laparoscope was introduced to keep the laparoscope outside, and surgical specimens were extracted using an Endocatch bag. In addition, as a case control study, we compared perioperative data of LESS adrenalectomy (LESS-A) with that of conventional laparoscopic adrenalectomy (LA). We performed transumbilical LESS-A for adrenal cortical adenoma in 12 cases, beginning in December, 2009. All procedures were successfully completed, with only one incision through the umbilicus, and without conversion to a standard laparoscopic approach. Mean operative time for LESS-A was 121.2 ± 7.8 min, which was slightly longer than LA (110.2 ± 7.3 min). For right adrenal tumors, we used a miniport (2 mm port) in addition to a SILS port, and were able to successfully perform adrenalectomy "with no visible scaring". Tumor laterality and patient BMI did not affect surgical morbidity in these procedures. Moreover, there was no significant difference between LESS-A and LA in blood loss, analgesic requirement, hospital stay, and scar satisfaction.
The transumbilical approach in LESS for adrenalectomy is safe and feasible and also improves cosmetic outcome compared with standard laparoscopic procedures. Improvements in surgical devices may aid the further development of this approach.

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    ABSTRACT: 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.
    Full-text · Article · Dec 2011 · International Journal of Urology
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    ABSTRACT: Purpose: To determine predictive factors for perioperative complications of laparoscopic adrenalectomy (LA) including single-site surgery performed or supervised by experienced laparoscopic surgeons. Patients and methods: 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. Results: 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. Conclusion: 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.
    No preview · Article · Sep 2012 · Journal of endourology / Endourological Society
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    ABSTRACT: Background: 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. Methods: 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. Results: 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. Conclusions: 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.
    No preview · Article · Oct 2012 · Surgical Endoscopy
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