Initial experience of transumbilical laparoendoscopic single-site surgery of partial adrenalectomy in patient with aldosterone-producing adenoma

Abstract

BackgroundLaparoscopic single-site surgery has recently emerged in the field of urology and this minimally-invasive surgery has resulted in a further reduction in morbidity compared with traditional laparoscopy. We present our initial experience with laparoendoscopic single-site surgery of partial adrenalectomy (LESS-PA) to treat aldosterone-producing adenomas.Case presentationA 60-year-old woman was diagnosed with aldosterone-producing macroadenomas in the left adrenal and aldosterone-producing microadenomas in the right adrenal. A two-step operation was planned. The first step involved transumbilical LESS-PA for the left adrenal tumors. A multichannel port was inserted through the center of the umbilicus and the left adrenal gland was approached using bent instruments according to standard traditional laparoscopic procedures. The tumors were resected using an ultrasonic scalpel, and the resected site was coagulated using a vessel sealing instrument and then sealed with fibrin glue. Operative time was 123 minutes and blood loss was minimal. The patient was discharged from hospital within 72 hours. Her right adrenal microadenomas will be treated in the next several months.ConclusionsAlthough our experience is limited, LESS-PA appears to be safe and feasible for treating aldosterone-producing adenomas. More cases and comparisons with the multiport technique are needed before drawing any definite conclusions concerning the technique.

A comparative study of multiport versus laparoendoscopic single-site adrenalectomy for benign adrenal tumors

“…Several early reports confirmed the feasibility and safety of LESS (transperitoneal or retroperitoneal) adrenalectomy for benign adrenal lesions, even pheochromocytomas [2,[7][8][9][10][11]. However, the clinical benefits of LESS adrenalectomy over multiport laparoscopic adrenalectomy still are under investigation.…”

“…This novel technique theoretically reduces the multiple-trocarrelated parietal trauma and its related complications. Early clinical series demonstrated the feasibility of LESS for benign adrenal lesions [2,[7][8][9][10][11][12].…”

Single‐Port Surgery

“…Once the spleen is completely free, a large endobag is inserted, pulled to the umbilical incision, and the spleen is retrieved intact or morcellated (Figure 8.19 ). [32,33] . A higher mean operative time was found in these early cases, due to several reasons.…”

SFE/SFHTA/AFCE consensus on primary aldosteronism, part 6: Adrenal surgery

“…Laparoscopic adrenalectomy usually requires 3 or 4 entry points, although an isolated transumbilical approach is also possible and less invasive [4]. Robot-assisted surgery is possible and without added risk, but expensive and without proven benefit over simple laparoscopic surgery [5][6][7].…”