title: Laparo-endoscopic single site anatomical retroperitoneoscopic adrenalectomy using conventional instruments: initial experience and short-term outcome.
abstract: OBJECTIVE
  To our knowledge we present the initial experience with and the short-term outcome of laparo-endoscopic single site anatomical retroperitoneoscopic adrenalectomy using conventional instruments.
  
  
  METHODS
  Between June 2009 and April 2010, 25 patients underwent laparo-endoscopic single site anatomical retroperitoneoscopic adrenalectomy. A TriPort™ Access System was inserted through a 2.5 to 3.0 cm transverse skin incision below the tip of the 12th rib. Adrenalectomy was done using a 5 mm 30-degree laparoscopic camera and 2 conventional laparoscopic instruments. After Gerota's fascia was incised we explored the first dissection plane between the perirenal fat and the anterior renal fascia at the superomedial side of the kidney. The adrenal gland was identified at the initial stage of the operation.
  
  
  RESULTS
  Laparo-endoscopic single site anatomical retroperitoneoscopic adrenalectomy was successfully accomplished in 23 patients. An additional 5 mm port was required in 1 of the 2 unsuccessful cases and in the other it was necessary to convert to standard anatomical retroperitoneoscopic adrenalectomy. Median incision length was 3.0 cm, median operative time was 55 minutes and median estimated blood loss was 15 ml. No major intraoperative complications occurred. In the initial 10 cases median operative time was significantly longer (62 vs 50 minutes) and median blood loss was significantly higher (75 vs 10, each p <0.001) than in the subsequent 15. In 3 cases pheochromocytoma was successfully excised without undesirable hemodynamic oscillation. Postoperative complications developed in 2 patients, including angina and contralateral atelectasis in 1 each.
  
  
  CONCLUSIONS
  In properly selected patients laparo-endoscopic single site anatomical retroperitoneoscopic adrenalectomy with conventional instruments is feasible, safe and effective, causes minimal morbidity and results in excellent cosmesis.
authors.affiliation: Department of Urology, Chinese People’s Liberation Army General Hospital, Military Postgraduate Medical College, Beijing, People’s Republic of China. xzhang@tjh.tjmu.edu.cn
authors.forename: Xu
authors.initials: X
authors.lastname: Zhang
authors.forename: Tao-ping
authors.initials: TP
authors.lastname: Shi
authors.forename: Hong-zhao
authors.initials: HZ
authors.lastname: Li
authors.forename: Xin
authors.initials: X
authors.lastname: Ma
authors.forename: Bao-jun
authors.initials: BJ
authors.lastname: Wang
mesh_terms: D000310:Adrenal Gland Neoplasms / Q000473:pathology / Q000601:surgery*; D000315:Adrenalectomy / Q000295:instrumentation / Q000379:methods*; D000328:Adult; D000368:Aged; D016063:Blood Loss, Surgical; D016009:Chi-Square Distribution; D015331:Cohort Studies; D004724:Endoscopy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D010147:Pain Measurement; D012187:Retroperitoneal Space / Q000601:surgery; D018709:Statistics, Nonparametric; D013997:Time Factors; D016896:Treatment Outcome