title: Longitudinal incision of the umbilicus for laparoendoscopic single site adrenalectomy: a particular intraumbilical technique.
abstract: BACKGROUND
  We describe our initial clinical experience of laparoendoscopic single site (LESS) adrenalectomy.
  
  
  METHODS
  We describe a 49-year-old woman who was diagnosed with subclinical Cushing syndrome because of a left adrenal tumor and underwent LESS adrenalectomy. We everted the umbilical depression and made the longitudinal skin incision of the umbilicus at the mid-line. Then, the wider area of the subcutaneous tissue was dissected to accommodate the placement of the 3 trocars through the longitudinal umbilical skin incision. The procedure was performed in a standard manner with the use of the roticular instruments to overcome the lack of triangulation that occurs with a single access.
  
  
  RESULTS
  There were no intraoperative or postoperative complications. The patient reported pain scores of 0 to 1 in the validated Visual Analog Pain Scale and postoperatively she required no narcotics. The scar receded into the umbilicus and was hardly visible.
  
  
  CONCLUSIONS
  Herein we presented the "particular intraumbilical approach" for LESS adrenalectomy. Longitudinal incision of the umbilicus and the wider area of subcutaneous tissue dissection accommodate the multiple ports and seemed to solve the problem associated with crossover instrumentation. The incision length was within the depression of the umbilicus; therefore, this simple technique also preserves the normal umbilical appearance.
authors.affiliation: Department of Urology, Graduate School of Medicine and Pharmaceutical Sciences for Research, University of Toyama, Toyama, Japan. nozaki0921@yahoo.co.jp
authors.forename: Tetsuo
authors.initials: T
authors.lastname: Nozaki
authors.forename: Keisuke
authors.initials: K
authors.lastname: Ichimatsu
authors.forename: Akihiko
authors.initials: A
authors.lastname: Watanabe
authors.forename: Akira
authors.initials: A
authors.lastname: Komiya
authors.forename: Hideki
authors.initials: H
authors.lastname: Fuse
mesh_terms: D000310:Adrenal Gland Neoplasms / Q000150:complications / Q000601:surgery; D000315:Adrenalectomy / Q000379:methods*; D003480:Cushing Syndrome / Q000209:etiology; D004210:Dissection / Q000379:methods; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008875:Middle Aged; D010147:Pain Measurement; D014472:Umbilicus / Q000601:surgery*