title: Transumbilical approach for laparo-endoscopic single-site adrenalectomy: initial experience and short-term outcome.
abstract: OBJECTIVE
  To report our initial experience with transumbilical laparo-endoscopic single-site adrenalectomy for adrenal tumors by using a single port with a multichannel cannula and bent laparoscopic instrumentation.
  
  
  METHODS
  Between December 2009 and December 2010, 30 patients underwent transumbilical laparo-endoscopic single-site adrenalectomy at our hospital. The procedure was carried out for adrenal cortical adenoma in 17 patients, adrenal pheochromocytoma in seven patients and other types of tumors in six patients. A multichannel port, bent laparoscopic instruments and Opti4 laparoscopic electrodes were used in all patients. The intraperitoneal space was approached through the umbilicus. The multichannel port was placed through a 2-cm incision at the inner edge of the umbilicus. A 5-mm flexible laparoscope was introduced to maintain an adequate laparoscopic view, and surgical specimens were extracted using an Endocatch bag.
  
  
  RESULTS
  All procedures were successfully completed, with only one incision through the umbilicus, and without conversion to a standard laparoscopic approach. Mean operative time was 120.1 ± 34.7 min. Tumor laterality and patient body mass index did not affect surgical morbidity. The initial 15 patients had a significantly longer mean pneumoperitoneum time (95.8 ± 37.5 min) than the last 15 patients (70.5 ± 18.7 min). Only one postoperative complication was observed (postoperative hematoma).
  
  
  CONCLUSIONS
  A transumbilical approach for laparo-endoscopic single-site adrenalectomy is safe and feasible, and it results in superior cosmesis. Improvements in surgical devices might facilitate further development of this approach.
authors.affiliation: Department of Urology, Keio University School of Medicine, Tokyo, Japan. akiram@sc.itc.keio.ac.jp
authors.forename: Akira
authors.initials: A
authors.lastname: Miyajima
authors.forename: Seiya
authors.initials: S
authors.lastname: Hattori
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: Eiji
authors.initials: E
authors.lastname: Kikuchi
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Asanuma
authors.forename: Ken
authors.initials: K
authors.lastname: Nakagawa
authors.forename: Mototsugu
authors.initials: M
authors.lastname: Oya
mesh_terms: D000306:Adrenal Cortex Neoplasms / Q000601:surgery*; D000310:Adrenal Gland Neoplasms / Q000601:surgery; D000315:Adrenalectomy / Q000379:methods*; D018246:Adrenocortical Adenoma / Q000601:surgery*; D000328:Adult; D003480:Cushing Syndrome / Q000601:surgery; D004724:Endoscopy / Q000379:methods*; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000517:prevention & control; D010535:Laparoscopy / Q000379:methods; D008297:Male; D008875:Middle Aged; D010673:Pheochromocytoma / Q000601:surgery; D011183:Postoperative Complications / Q000517:prevention & control; D016896:Treatment Outcome; D014472:Umbilicus / Q000601:surgery*