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Laparoendoscopic single-site retroperitoneoscopic adrenalectomy: a matched-pair comparison with the gold standard.

Shi TP, Zhang X, Ma X, Li HZ, Zhu J, Wang BJ, Gao JP, Cai W, Dong J - Surg Endosc (2010)

Bottom Line: Between June and December 2009, 19 patients underwent LESS-ARA, and their outcomes were compared with a contemporary 1:2 matched-pair cohort of 38 patients who underwent standard ARA by the same surgeon.The following parameters were compared between the two groups: demographics, details of the surgery, perioperative complications, postoperative visual analog pain scale score, analgesic requirement, and short-term measures of convalescence.The LESS-ARA group had a longer median operative time (55 vs 41.5 min; p=0.0004), whereas the in-hospital use of analgesics was significantly less (5 vs 12 morphine equivalents; p=0.03).

View Article: PubMed Central - PubMed

Affiliation: Department of Urology, Chinese People's Liberation Army General Hospital, Military Postgraduate Medical College, 28 Fuxing Road, Haidian District, 100853, Beijing, China.

ABSTRACT

Background: Laparoscopic adrenalectomy has become the gold-standard for the surgical treatment of most adrenal lesions. This study evaluated the operative outcome of laparoendoscopic single-site (LESS) retroperitoneoscopic adrenalectomy (LESS-ARA) in comparison with the current standard operation procedure.

Methods: Between June and December 2009, 19 patients underwent LESS-ARA, and their outcomes were compared with a contemporary 1:2 matched-pair cohort of 38 patients who underwent standard ARA by the same surgeon. In LESS-ARA, a multichannel port was inserted through a 2.5- to 3.0-cm transverse skin incision below the tip of the 12th rib. The LESS-ARA procedure was performed using a 5-mm 30º laparoscopic camera and two standard laparoscopic instruments. The following parameters were compared between the two groups: demographics, details of the surgery, perioperative complications, postoperative visual analog pain scale score, analgesic requirement, and short-term measures of convalescence.

Results: The finding showed that LESS-ARA and standard ARA were comparable in terms of the estimated blood loss (30 vs 17.5 ml; p=0.64), postoperative hospital stay (6 vs 6 days; p=0.67), and postoperative complications (2 vs 3 patients; p=1.00) for patients with similar baseline demographics and median tumor size (2.1 vs 3.0; p=0.18) cm. The intraoperative hemodynamic values were similar in the two groups. The LESS-ARA group had a longer median operative time (55 vs 41.5 min; p=0.0004), whereas the in-hospital use of analgesics was significantly less (5 vs 12 morphine equivalents; p=0.03).

Conclusions: The LESS retroperitoneoscopic adrenalectomy approach is feasible and offers a superior cosmetic outcome and better pain control, with perioperative outcomes and short-term measures of convalescence similar to those of the standard approach, albeit with a longer operative time.

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Related in: MedlinePlus

Internal views of the laparoendoscopic single-site retroperitoneoscopic adrenalectomy (LESS-ARA) procedure. A Gerota’s fascia is incised longitudinally along the posterior peritoneal reflection (white arrows) .B The adrenal tumor (AT) is identified in the first dissection plane between the perirenal fat and the anterior Gerota’s fascia (GF) located at the superomedial side of the upper kidney pole (UKP). C By grasping the periadrenal fat cephalad, the bottom of the adrenal gland or tumor is separated from the parenchymal surface of the upper kidney pole, after which the third dissection plane is developed. D The upper adrenal arteries (UAA) are transected
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Fig2: Internal views of the laparoendoscopic single-site retroperitoneoscopic adrenalectomy (LESS-ARA) procedure. A Gerota’s fascia is incised longitudinally along the posterior peritoneal reflection (white arrows) .B The adrenal tumor (AT) is identified in the first dissection plane between the perirenal fat and the anterior Gerota’s fascia (GF) located at the superomedial side of the upper kidney pole (UKP). C By grasping the periadrenal fat cephalad, the bottom of the adrenal gland or tumor is separated from the parenchymal surface of the upper kidney pole, after which the third dissection plane is developed. D The upper adrenal arteries (UAA) are transected

Mentions: Because all the adrenal tumors in this series were smaller than 4 cm, the second dissection plane, between the perirenal fat and the posterior renal fascia located on the lateral side of the upper kidney pole, was omitted in both groups. The dissections proceeded in the avascular plane located on the parenchymal surface of the upper renal pole. The adrenal vein was dealt with at the final stage of the surgery. A detailed photographic representation of the LESS-ARA procedure is shown in Fig. 2.Fig. 2


Laparoendoscopic single-site retroperitoneoscopic adrenalectomy: a matched-pair comparison with the gold standard.

Shi TP, Zhang X, Ma X, Li HZ, Zhu J, Wang BJ, Gao JP, Cai W, Dong J - Surg Endosc (2010)

Internal views of the laparoendoscopic single-site retroperitoneoscopic adrenalectomy (LESS-ARA) procedure. A Gerota’s fascia is incised longitudinally along the posterior peritoneal reflection (white arrows) .B The adrenal tumor (AT) is identified in the first dissection plane between the perirenal fat and the anterior Gerota’s fascia (GF) located at the superomedial side of the upper kidney pole (UKP). C By grasping the periadrenal fat cephalad, the bottom of the adrenal gland or tumor is separated from the parenchymal surface of the upper kidney pole, after which the third dissection plane is developed. D The upper adrenal arteries (UAA) are transected
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3116116&req=5

Fig2: Internal views of the laparoendoscopic single-site retroperitoneoscopic adrenalectomy (LESS-ARA) procedure. A Gerota’s fascia is incised longitudinally along the posterior peritoneal reflection (white arrows) .B The adrenal tumor (AT) is identified in the first dissection plane between the perirenal fat and the anterior Gerota’s fascia (GF) located at the superomedial side of the upper kidney pole (UKP). C By grasping the periadrenal fat cephalad, the bottom of the adrenal gland or tumor is separated from the parenchymal surface of the upper kidney pole, after which the third dissection plane is developed. D The upper adrenal arteries (UAA) are transected
Mentions: Because all the adrenal tumors in this series were smaller than 4 cm, the second dissection plane, between the perirenal fat and the posterior renal fascia located on the lateral side of the upper kidney pole, was omitted in both groups. The dissections proceeded in the avascular plane located on the parenchymal surface of the upper renal pole. The adrenal vein was dealt with at the final stage of the surgery. A detailed photographic representation of the LESS-ARA procedure is shown in Fig. 2.Fig. 2

Bottom Line: Between June and December 2009, 19 patients underwent LESS-ARA, and their outcomes were compared with a contemporary 1:2 matched-pair cohort of 38 patients who underwent standard ARA by the same surgeon.The following parameters were compared between the two groups: demographics, details of the surgery, perioperative complications, postoperative visual analog pain scale score, analgesic requirement, and short-term measures of convalescence.The LESS-ARA group had a longer median operative time (55 vs 41.5 min; p=0.0004), whereas the in-hospital use of analgesics was significantly less (5 vs 12 morphine equivalents; p=0.03).

View Article: PubMed Central - PubMed

Affiliation: Department of Urology, Chinese People's Liberation Army General Hospital, Military Postgraduate Medical College, 28 Fuxing Road, Haidian District, 100853, Beijing, China.

ABSTRACT

Background: Laparoscopic adrenalectomy has become the gold-standard for the surgical treatment of most adrenal lesions. This study evaluated the operative outcome of laparoendoscopic single-site (LESS) retroperitoneoscopic adrenalectomy (LESS-ARA) in comparison with the current standard operation procedure.

Methods: Between June and December 2009, 19 patients underwent LESS-ARA, and their outcomes were compared with a contemporary 1:2 matched-pair cohort of 38 patients who underwent standard ARA by the same surgeon. In LESS-ARA, a multichannel port was inserted through a 2.5- to 3.0-cm transverse skin incision below the tip of the 12th rib. The LESS-ARA procedure was performed using a 5-mm 30º laparoscopic camera and two standard laparoscopic instruments. The following parameters were compared between the two groups: demographics, details of the surgery, perioperative complications, postoperative visual analog pain scale score, analgesic requirement, and short-term measures of convalescence.

Results: The finding showed that LESS-ARA and standard ARA were comparable in terms of the estimated blood loss (30 vs 17.5 ml; p=0.64), postoperative hospital stay (6 vs 6 days; p=0.67), and postoperative complications (2 vs 3 patients; p=1.00) for patients with similar baseline demographics and median tumor size (2.1 vs 3.0; p=0.18) cm. The intraoperative hemodynamic values were similar in the two groups. The LESS-ARA group had a longer median operative time (55 vs 41.5 min; p=0.0004), whereas the in-hospital use of analgesics was significantly less (5 vs 12 morphine equivalents; p=0.03).

Conclusions: The LESS retroperitoneoscopic adrenalectomy approach is feasible and offers a superior cosmetic outcome and better pain control, with perioperative outcomes and short-term measures of convalescence similar to those of the standard approach, albeit with a longer operative time.

Show MeSH
Related in: MedlinePlus