title: Perioperative outcomes and cosmesis analysis of patients undergoing laparoendoscopic single-site adrenalectomy: a comparison of transumbilical, transperitoneal subcostal, and retroperitoneal subcostal approaches.
abstract: OBJECTIVE
  To compare the perioperative outcomes and cosmetic results for transumbilical (TU), transperitoneal subcostal (TS), and retroperitoneal subcostal (RS) laparoendoscopic single-site surgery (LESS) adrenalectomy (AD).
  
  
  METHODS
  An observational study was conducted of patients who were had undergone LESS-AD using a TU (n = 9), TS (n = 17), or RS (n = 16) approach. The perioperative outcomes and comprehensive cosmetic results were analyzed statistically.
  
  
  RESULTS
  The RS-LESS-AD patients were more likely to have an indication for surgery of a right adrenal mass (TU-LESS-AD 11.1% and TS-LESS-AD 5.9% vs RS-LESS-AD 43.8%, P = .016) or partial AD (0% vs 9% vs 87.5%, P < .001). The TU-LESS-AD procedures had a longer median operative time but significantly lower postoperative pain. The median cosmesis rating for the TU-LESS-AD, TS-LESS-AD, and RS-LESS-AD scar photographs was 10, 8, and 9, respectively (P = .010). Only the cosmesis ratings after the photograph viewing were statistically significant across the surgical approaches (9.5 vs 8 vs 9, P = .048). Assuming equivalent surgical complication risks across the approaches, the preference for future TU-LESS-AD, TS-LESS-AD, RS-LESS-AD was 86%, 6%, and 8%, respectively. As the theoretical risk of TU-LESS-AD increased, the preference for TU-LESS-AD decreased and the preference for TS-LESS-AD and RS-LESS-AD increased.
  
  
  CONCLUSIONS
  LESS-AD is an effective procedure with a high level of cosmesis using a TU, TS, or RS approach. The surgeon's background, patient characteristics, and cosmetic perception must be carefully considered as a part of the entire clinical picture so that LESS-AD can be used for patients who will derive the most benefit.
authors.affiliation: Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai, People's Republic of China.
authors.forename: Linhui
authors.initials: L
authors.lastname: Wang
authors.forename: Chen
authors.initials: C
authors.lastname: Cai
authors.forename: Bing
authors.initials: B
authors.lastname: Liu
authors.forename: Qing
authors.initials: Q
authors.lastname: Yang
authors.forename: Zhenjie
authors.initials: Z
authors.lastname: Wu
authors.forename: Liang
authors.initials: L
authors.lastname: Xiao
authors.forename: Bo
authors.initials: B
authors.lastname: Yang
authors.forename: Wei
authors.initials: W
authors.lastname: Chen
authors.forename: Zunli
authors.initials: Z
authors.lastname: Xu
authors.forename: Shangqing
authors.initials: S
authors.lastname: Song
authors.forename: Yinghao
authors.initials: Y
authors.lastname: Sun
mesh_terms: D000315:Adrenalectomy / Q000009:adverse effects / Q000379:methods*; D000328:Adult; D000368:Aged; D001828:Body Image; D002921:Cicatrix / Q000209:etiology / Q000523:psychology*; D004954:Esthetics; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D010149:Postoperative Pain / Q000209:etiology; D017060:Patient Satisfaction; D059035:Perioperative Period; D012307:Risk Factors; D018709:Statistics, Nonparametric; D011795:Surveys and Questionnaires; D055815:Young Adult