title: Laparoendoscopic single-site (LESS) retroperitoneal partial adrenalectomy using a custom-made single-access platform and standard laparoscopic instruments: technical considerations and surgical outcomes.
abstract: BACKGROUND
  We previously reported our initial experience with laparoendoscopic single-site (LESS) retroperitoneal partial adrenalectomy using a custom-made single-port device and conventional straight laparoscopic instruments.
  
  
  METHODS
  Between December 2010 and February 2012, LESS retroperitoneal partial adrenalectomies were performed in 11 patients. Six patients had aldosterone-producing adenomas (APAs) and five patients had nonfunctioning tumors. A single-port access was created with an Alexis wound retractor (Applied Medical, Rancho Santa Margarita, CA, USA) through an incision of 2-3 cm beneath the tip of the 12th rib. All procedures were performed with straight laparoscopic instruments.
  
  
  RESULTS
  All LESS procedures were successfully completed without conversion to traditional laparoscopic conversion. The tumors ranged from 1 cm to 4.7 cm (mean, 2.3 cm). The operative time was 71-257 minutes (mean, 121 minutes). Most patients (n = 8) had minimal blood loss; the other three patients had a blood loss of 150 mL, 100 mL, and 100 mL. The mean hospital stay was 3 days (range, 1-6 days). There were no perioperative or postoperative complications. Pathological examinations revealed negative surgical margins in all specimens. All patients with Conn's syndrome had an improvement in blood pressure and normalization of plasma renin activity and serum aldosterone levels; all patients were free of potassium supplementation.
  
  
  CONCLUSIONS
  Our results clearly demonstrate that LESS retroperitoneal partial adrenalectomy can be performed safely and effectively using a custom-made single-access platform and standard laparoscopic instruments.
authors.affiliation: Department of Urology, National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Chen-Hsun
authors.initials: CH
authors.lastname: Ho
authors.affiliation: Department of Neurology, Cathay General Hospital, Taipei, Taiwan; Department of Medicine, School of Medicine, Fu Jen Catholic University, Taipei, Taiwan.
authors.forename: Pin-Wen
authors.initials: PW
authors.lastname: Liao
authors.affiliation: Department of Urology, E-Da Hospital, Kaohsiung, Taiwan; Department of Healthcare Administration, I-Shou University, Kaohsiung, Taiwan.
authors.forename: Victor C
authors.initials: VC
authors.lastname: Lin
authors.affiliation: Institute of Biomedical Engineering, National Taiwan University, Taipei, Taiwan.
authors.forename: Fu-Shan
authors.initials: FS
authors.lastname: Jaw
authors.affiliation: Glickman Urological and Kidney Institute and Lerner College of Medicine, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Shih-Chieh Jeff
authors.initials: SC
authors.lastname: Chueh
authors.affiliation: Division of Urology, Department of Surgery, Far Eastern Memorial Hospital, Ban Ciao, Taipei, Taiwan.
authors.forename: Shiu-Dong
authors.initials: SD
authors.lastname: Chung
authors.affiliation: Department of Urology, National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Shih-Ping
authors.initials: SP
authors.lastname: Liu
authors.affiliation: Division of Urology, Department of Surgery, Buddhist Tzu Chi General Hospital, Taipei Branch, Taipei, Taiwan; Department of Urology, College of Medicine, Tzu Chi University, Hualien, Taiwan. Electronic address: tsai1970523@yahoo.com.tw.
authors.forename: Yao-Chou
authors.initials: YC
authors.lastname: Tsai
authors.affiliation: Department of Urology, National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Hong-Jeng
authors.initials: HJ
authors.lastname: Yu
mesh_terms: D000306:Adrenal Cortex Neoplasms / Q000601:surgery*; D000315:Adrenalectomy / Q000295:instrumentation* / Q000379:methods*; D018246:Adrenocortical Adenoma / Q000601:surgery*; D000368:Aged; D005260:Female; D006801:Humans; D006929:Hyperaldosteronism / Q000601:surgery*; D010535:Laparoscopy / Q000295:instrumentation* / Q000379:methods*; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D011183:Postoperative Complications / Q000209:etiology*; D012187:Retroperitoneal Space / Q000601:surgery; D013525:Surgical Instruments; D016896:Treatment Outcome
keywords: laparoendoscopic single-site; laparoscopy; partial adrenalectomy