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.
FINDINGS: 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.
CONCLUSIONS: 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.