title: Laparoendoscopic single-site surgery for left adrenalectomy: standardization of technique.
abstract: OBJECTIVE
  We developed step-by-step standardization of left adrenalectomy using laparoendoscopic single-site surgery (LESS) and evaluated the efficacy and safety of this surgical procedure.
  
  
  METHODS
  To simplify the procedure, we used a technique that involved handling one straight operating instrument and crossing over another articulated assistant instrument intracorporeally. We classified the reciprocal positions of the two instruments into four types. The surgical procedures were divided into six steps, and we applied one of the four types of position to each step.
  
  
  RESULTS
  Seven patients with left adrenal tumor underwent LESS by two operators. Five received left total adrenalectomy, one left partial adrenalectomy, and one bilateral total adrenalectomy. Mean operative time was 178 minutes. Blood loss was minimal (≤50  mL), and convalescence was uneventful in all patients.
  
  
  CONCLUSIONS
  Although there is inevitably a learning curve, LESS left adrenalectomy can be safely introduced by beginners using a step-by-step standardized technique.
authors.affiliation: Department of Urology, Kyoto University Graduate School of Medicine, Kyoto, Japan. ky7527@kuhp.kyoto-u.ac.jp
authors.forename: Koji
authors.initials: K
authors.lastname: Yoshimura
authors.forename: Kazutoshi
authors.initials: K
authors.lastname: Okubo
authors.forename: Yoshiyuki
authors.initials: Y
authors.lastname: Matsui
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Nishiyama
authors.forename: Osamu
authors.initials: O
authors.lastname: Ogawa
mesh_terms: D000315:Adrenalectomy / Q000379:methods* / Q000592:standards*; D000368:Aged; D005260:Female; D006801:Humans; D007430:Intraoperative Care; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D012015:Reference Standards; D013997:Time Factors