title: Laparoendoscopic single-site retroperitoneoscopic adrenalectomy: a matched-pair comparison with the gold standard.
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.
authors.affiliation: Department of Urology, Chinese People's Liberation Army General Hospital, Military Postgraduate Medical College, 28 Fuxing Road, Haidian District, 100853, Beijing, China.
authors.forename: Tao-ping
authors.initials: TP
authors.lastname: Shi
authors.forename: Xu
authors.initials: X
authors.lastname: Zhang
authors.forename: Xin
authors.initials: X
authors.lastname: Ma
authors.forename: Hong-zhao
authors.initials: HZ
authors.lastname: Li
authors.forename: Jie
authors.initials: J
authors.lastname: Zhu
authors.forename: Bao-jun
authors.initials: BJ
authors.lastname: Wang
authors.forename: Jiang-ping
authors.initials: JP
authors.lastname: Gao
authors.forename: Wei
authors.initials: W
authors.lastname: Cai
authors.forename: Juan
authors.initials: J
authors.lastname: Dong
mesh_terms: D000310:Adrenal Gland Neoplasms / Q000601:surgery*; D000315:Adrenalectomy / Q000379:methods*; D000700:Analgesics / Q000627:therapeutic use; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data; D016022:Case-Control Studies; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000700:Analgesics