Laparoendoscopic Single-Site Adrenalectomy sans Transumbilical Approach: Initial Experience in Japan

Purpose: The use of laparoendoscopic single-site (LESS) surgery has been increasing. The LESS procedure has been done for various urological diseases and studies have shown that it results in less pain, shorter hospital stays and excellent cosmetic outcomes. Materials and Methods: We describe our initial experience with LESS adrenalectomy without the use of the transumbilical approach. The participants were 16 consecutive patients who underwent LESS adrenalectomy using a SILS portTM (Covidien, Mansfield, MA, USA) at Hiroshima University Hospital. Various parameters including the insufflation time, estimated blood loss, resumption of oral intake and complications were analyzed. Results: The adrenalectomy was completed successfully with no major intraoperative complications in 15 of the patients. One LESS adrenalectomy was converted to a conventional laparoscopic adrenalectomy by placement of two additional 12 mm trocars; this patient was therefore excluded from the study. The mean (range) patient age was 53.8 (35-69) years, body mass index (BMI) was 23.5 (20.7-27.2) kg/m2, tumor size was 19.8 (9-45) mm, insufflation time was 188.0 (95-340) min and estimated blood loss was 36.3 (10-80) mL. In all cases articulating instruments were used for satisfactory dissection and triangulation. One bowel injury (serosal) occurred and was repaired in the open laparotomy before SILS portTM insertion. All patients at the follow-up visit were satisfied and pleased with their scars. Conclusion: We found LESS adrenalectomy to be apparently safe, effective and minimally invasive for adrenal diseases. In our opinion, LESS adrenalectomy without using the transumbilical approach is feasible and easy to introduce.