title: Retroperitoneoscopic adrenalectomy for adrenal tumors via a single large port.
abstract: OBJECTIVE
  Laparoscopic adrenalectomy is generally performed with carbon dioxide insufflation of the cavity and requires multiple trocars. This study reports the outcomes of retroperitoneoscopic adrenalectomy (RA) for adrenal tumors via a single port using a large cylinder without carbon dioxide insufflation.
  
  
  METHODS
  Fifty-four patients with adrenal tumors were treated using RA via a single large port. The average tumor size was 2.6 cm. For surgery, patients were placed in the lateral decubitus position with slight flexion, and a 4.5-cm skin incision was performed below the 12th rib in the midaxillary line. The retroperitoneal space was dissected using index fingers and a balloon dilator. A rectoscope tube with a 4-cm diameter was inserted, and the adrenal glands were removed endoscopically via the single large port without carbon dioxide insufflation.
  
  
  RESULTS
  This procedure was completed in 53 patients (98.1%). The average duration of surgery was 203 minutes, and the mean estimated blood loss was 252 mL. Four patients (7.4%) required blood transfusion. Postoperative major complications, including fulminant hepatitis and pulmonary thrombosis, were observed in two patients (3.7%), and the patient with hepatic disease died on the 14th postoperative day. The mortality rate after surgery thus was 1.9%. However, no local tumor recurrence or hormonal relapse has occurred at a median follow-up of 34 months.
  
  
  CONCLUSIONS
  This procedure appears to be effective and relatively minimally invasive. However, it is limited by the narrow working space and restriction of the manipulation of instruments.
authors.affiliation: Department of Urology, Nihon University School of Medicine, Tokyo, Japan. byd04561@nifty.com
authors.forename: Daisaku
authors.initials: D
authors.lastname: Hirano
authors.forename: Sadatsugu
authors.initials: S
authors.lastname: Minei
authors.forename: Kenya
authors.initials: K
authors.lastname: Yamaguchi
authors.forename: Tetsuo
authors.initials: T
authors.lastname: Yoshikawa
authors.forename: Takahiko
authors.initials: T
authors.lastname: Hachiya
authors.forename: Toshio
authors.initials: T
authors.lastname: Yoshida
authors.forename: Hajime
authors.initials: H
authors.lastname: Ishida
authors.forename: Yukie
authors.initials: Y
authors.lastname: Takimoto
authors.forename: Tadao
authors.initials: T
authors.lastname: Saitoh
authors.forename: Shuji
authors.initials: S
authors.lastname: Kiyotaki
authors.forename: Kiyoki
authors.initials: K
authors.lastname: Okada
mesh_terms: D000310:Adrenal Gland Neoplasms / Q000601:surgery*; D000315:Adrenalectomy / Q000009:adverse effects / Q000379:methods*; D000328:Adult; D000368:Aged; D016063:Blood Loss, Surgical; D001803:Blood Transfusion / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012187:Retroperitoneal Space; D016896:Treatment Outcome