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      Laparoscopic Single Site Adrenalectomy Using a Conventional Laparoscope and Instrumentation

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          Abstract

          These authors conclude that laparoscopic single site adrenalectomy can be performed without articulating instruments or a flexible laparoscope.

          Abstract

          Background and Objectives:

          We present a case of Laparoendoscopic Single Site Surgery (LESS) left adrenalectomy performed with a conventional laparoscope and instruments.

          Methods:

          A 45-year-old male was diagnosed with hyperaldosteronism. Computed tomography detected a left adrenal nodule. Bilateral adrenal vein sampling was consistent with a left-sided source for hyperaldosteronism.

          Results:

          Total operative time for LESS left adrenalectomy was 120 minutes. The surgery was performed with conventional instruments, a standard 5-mm laparoscope, and a SILS port, with no additional incisions or trocars needed. No complications occurred, and the patient reported an uneventful recovery.

          Conclusions:

          LESS adrenalectomy is a feasible procedure. Although articulating instruments and laparoscopes may offer advantages, LESS adrenalectomy can be done without these.

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          Most cited references7

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          Laparoscopic adrenalectomy in Cushing's syndrome and pheochromocytoma.

          M Gagner, A. LaCroix, E Bolté (1992)
          Article 0 comments Cited 212 times – based on 0 reviews     Review now
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            Open and laparoscopic adrenalectomy: analysis of the National Surgical Quality Improvement Program.

            Tamer Mahmoud Tamer, James Crainey, Florence E Turrentine … (2008)
            Numerous series demonstrate the benefits of laparoscopic versus open adrenalectomy, but fail to adjust for confounding factors. This study uses the Veterans Affairs National Surgical Quality Improvement Program database to compare these two approaches, adjusting for baseline differences. Laparoscopic (n=358) and open (n=311) adrenalectomy data were collected at 123 Department of Veterans Affairs and 14 university hospitals from October 1, 2001 to September 30, 2004. Preoperative characteristics, operative data, and 30-day outcomes were compared using the chi-square or Fisher's exact test for categorical variables and the t-test for continuous variables. Unadjusted odds ratio (OR) and 95% confidence interval (CI) were computed for the effect of operative approach on postoperative morbidity. Adjusted odds ratios and 95% CI were computed for this same effect, adjusting for variables that were predictive of outcomes or imbalanced at baseline. Data are reported as means +/-SD, unless otherwise indicated. Patients undergoing open adrenalectomy were more likely to be older (57.8+/-11.9 years versus 53.5+/-13.2 years, p < 0.0001), harbor malignancy (44.5% versus 13.5%, p < 0.0001), have higher American Society of Anesthesiologists classifications (p=0.0037), smoke (35.4% versus 22.6%, p=0.0003), and have lower serum albumin levels (3.9+/-0.5 g/dL versus 4.0+/-0.5 g/dL, p=0.0241). Open procedures had increased operative times (3.9+/-1.8 hours versus 2.9+/-1.3 hours, p < 0.0001), transfusion requirements (0.7+/-1.8 U versus 0.1+/-0.5 U, p<0.0001), reoperations (4.8% versus 1.4%, p=0.0094), length of stay (9.4+/-11.0 days versus 4.1+/-4.7 days, p < 0.0001) and 30-day morbidity rates (17.4% versus 3.6%, p < 0.0001) with unadjusted and adjusted odds ratio (95% CI) of 5.52 (2.94, 10.33), and 3.97 (1.92, 8.22), respectively. Open procedures resulted in more pneumonia, unplanned intubation, unsuccessful ventilator wean, systemic sepsis, cardiac arrest, renal insufficiency, and wound infections. Even after adjustment for confounding factors, 30-day morbidity was much higher for patients having open adrenalectomy.
            Article 0 comments Cited 28 times – based on 0 reviews     Review now
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              Laparoendoscopic single-site and conventional laparoscopic adrenalectomy: a matched case-control study.

              Christopher Y. Park, D Han, Hyeon Hoe Kim … (2009)
              The purpose of this study was to describe our initial clinical experience and assess the feasibility of laparoendoscopic single-site surgery (LESS) in the treatment of benign adrenal adenoma. Nine patients undergoing LESS adrenalectomy for benign adrenal adenoma were compared with 17 patients undergoing conventional laparoscopic adrenalectomy. Controls were matched for age, sex, surgical indications, and tumor size via a statistically generated selection of all conventional laparoscopic adrenalectomies performed during the same period of time. No significant differences in the mean operative time (169 vs. 144.5 minutes, p = 0.287), blood loss (177.8 vs. 204.7 mL, p = 0.792), and postoperative hospital stay (3.2 vs. 3.5 days, p = 0.525) were observed between the LESS and conventional laparoscopy group. However, postoperative pain, as measured by the number of days of intravenous (IV) patient controlled anesthesia use, was significantly lower in the LESS group (0.9 vs. 1.9 days, p = 0.047). Perioperative complications were similar between the two groups. LESS adrenalectomy for benign adrenal adenoma is comparable to the conventional laparoscopic approach with regard to the operative time, blood loss, length of hospital stay, and degree of complication, and has demonstrated more desirable cosmetic outcomes.
              Article 0 comments Cited 23 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): JSLS
                Journal ID (iso-abbrev): JSLS
                Journal ID (hwp): jsls
                Journal ID (pmc): jsls
                Journal ID (publisher-id): JSLS
                Title: JSLS : Journal of the Society of Laparoendoscopic Surgeons
                Publisher: Society of Laparoendoscopic Surgeons (Miami, FL )
                ISSN (Print): 1086-8089
                ISSN (Electronic): 1938-3797
                Publication date (Print): Apr-Jun 2011
                Volume: 15
                Issue: 2
                Pages: 236-238
                Affiliations
                Department of Surgery, Mount Sinai School of Medicine, New York, New York, USA.
                Author notes

                Modesto J. Colon attests to full access of all information in the study and takes responsibility for the integrity of the data.

                Address correspondence to: Edward H. Chin, MD, FACS, Assistant Professor of Surgery, The Mount Sinai School of Medicine, 5 E. 98th St, Box 1259, New York, New York 10029, USA. Telephone: (212) 241-2115, Fax: (212) 241-5979, E-mail: Edward.chin@ 123456mountsinai.org
                Article
                Publisher ID: 10-05-082
                DOI: 10.4293/108680811X13071180407195
                PMC ID: 3148879
                PubMed ID: 21902983
                SO-VID: ce5365ee-8298-49fb-a16f-43143e58e204
                Copyright © © 2011 by JSLS, Journal of the Society of Laparoendoscopic Surgeons.
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives License ( http://creativecommons.org/licenses/by-nc-nd/3.0/), which permits for noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited and is not altered in any way.

                History
                Categories
                Subject: Case Reports

                ScienceOpen disciplines: Surgery
                Keywords: single site surgery,laparoscopic adrenalectomy,laparoendoscopic single site surgery (less)
                Data availability:
                ScienceOpen disciplines: Surgery
                Keywords: single site surgery, laparoscopic adrenalectomy, laparoendoscopic single site surgery (less)

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