title: Transumbilical laparo-endoscopic single site surgery for adrenal cortical adenoma inducing primary aldosteronism: initial experience.
abstract: BACKGROUND
  We have started using laparo-endoscopic single-site surgery (LESS) in urologic surgery, although its use has not gained momentum due to its level of difficulty. We here report our initial experience with transumbilical LESS for adrenal cortical adenoma by using a single port with a multichannel cannula (SILS port) and bent laparoscopic instrumentation.
  
  
  RESULTS
  A multichannel port (SILS port), bent laparoscopic instrument (Roticulator Endo Mini-Shears) and Opti4 laparoscopic electrodes were used in all cases. The intraperitoneal space was approached through the umbilicus. The SILS port was placed through a 2 cm incision at the inner edge of the umbilicus. A 5 mm flexible laparoscope was introduced to keep the laparoscope outside, and surgical specimens were extracted using an Endocatch bag. In addition, as a case control study, we compared perioperative data of LESS adrenalectomy (LESS-A) with that of conventional laparoscopic adrenalectomy (LA). We performed transumbilical LESS-A for adrenal cortical adenoma in 12 cases, beginning in December, 2009. All procedures were successfully completed, with only one incision through the umbilicus, and without conversion to a standard laparoscopic approach. Mean operative time for LESS-A was 121.2 ± 7.8 min, which was slightly longer than LA (110.2 ± 7.3 min). For right adrenal tumors, we used a miniport (2 mm port) in addition to a SILS port, and were able to successfully perform adrenalectomy "with no visible scaring". Tumor laterality and patient BMI did not affect surgical morbidity in these procedures. Moreover, there was no significant difference between LESS-A and LA in blood loss, analgesic requirement, hospital stay, and scar satisfaction.
  
  
  CONCLUSIONS
  The transumbilical approach in LESS for adrenalectomy is safe and feasible and also improves cosmetic outcome compared with standard laparoscopic procedures. Improvements in surgical devices may aid the further development of this approach.
authors.affiliation: Keio University School of Medicine, Department of Urology, 35 Shinanomachi, Shinjuku, Tokyo 160-8582, Japan. akiram@sc.itc.keio.ac.jp.
authors.forename: Akira
authors.initials: A
authors.lastname: Miyajima
authors.forename: Takahiro
authors.initials: T
authors.lastname: Maeda
authors.forename: Masanori
authors.initials: M
authors.lastname: Hasegawa
authors.forename: Toshikazu
authors.initials: T
authors.lastname: Takeda
authors.forename: Masaru
authors.initials: M
authors.lastname: Ishida
authors.forename: Takeo
authors.initials: T
authors.lastname: Kosaka
authors.forename: Eiji
authors.initials: E
authors.lastname: Kikuchi
authors.forename: Ken
authors.initials: K
authors.lastname: Nakagawa
authors.forename: Mototsugu
authors.initials: M
authors.lastname: Oya