title: Laparoendoscopic single-site adrenalectomy sans transumbilical approach: initial experience in Japan.
abstract: OBJECTIVE
  The use of laparoendoscopic single-site (LESS) surgery has been increasing. The LESS procedure has been done for various urological diseases and studies have shown that it results in less pain, shorter hospi­tal stays and excellent cosmetic outcomes.
  
  
  METHODS
  We describe our initial experience with LESS adrenalectomy without the use of the transumbilical approach. The participants were 16 consecutive patients who underwent LESS adrenalectomy using a SILS port™ (Covidien, Mansfield, MA, USA) at Hiroshima University Hospital. Various parameters including the insufflation time, estimated blood loss, resumption of oral intake and complications were ana­lyzed.
  
  
  RESULTS
  The adrenalectomy was completed successfully with no major intraoperative complications in 15 of the patients. One LESS adrenalectomy was converted to a conventional laparoscopic adrenalectomy by placement of two additional 12 mm trocars; this patient was therefore excluded from the study. The mean (range) patient age was 53.8 (35-69) years, body mass index (BMI) was 23.5 (20.7-27.2) kg/m2, tumor size was 19.8 (9-45) mm, insufflation time was 188.0 (95-340) min and estimated blood loss was 36.3 (10-80) mL. In all cases articulating instruments were used for satisfactory dissection and triangulation. One bowel injury (serosal) occurred and was repaired in the open laparotomy before SILS port™ insertion. All patients at the follow-up visit were satisfied and pleased with their scars.
  
  
  CONCLUSIONS
  We found LESS adrenalectomy to be apparently safe, effective and minimally invasive for ad­renal diseases. In our opinion, LESS adrenalectomy without using the transumbilical approach is feasible and easy to introduce.
authors.affiliation: Department of Urolgy,Hiroshima University Graduate School of Biomedical Sciences, Hiroshima, Japan. inosyogo@hiroshimau.ac.jp.
authors.forename: Shogo
authors.initials: S
authors.lastname: Inoue
authors.affiliation: Department of Urolgy,Hiroshima University Graduate School of Biomedical Sciences, Hiroshima, Japan.
authors.forename: Kenichiro
authors.initials: K
authors.lastname: Ikeda
authors.affiliation: Department of Urolgy,Hiroshima University Graduate School of Biomedical Sciences, Hiroshima, Japan.
authors.forename: Mitsuru
authors.initials: M
authors.lastname: Kajiwara
authors.affiliation: Department of Urolgy,Hiroshima University Graduate School of Biomedical Sciences, Hiroshima, Japan.
authors.forename: Jun
authors.initials: J
authors.lastname: Teishima
authors.affiliation: Department of Urolgy,Hiroshima University Graduate School of Biomedical Sciences, Hiroshima, Japan.
authors.forename: Akio
authors.initials: A
authors.lastname: Matsubara
mesh_terms: D000310:Adrenal Gland Neoplasms / Q000473:pathology* / Q000601:surgery*; D000315:Adrenalectomy / Q000009:adverse effects / Q000379:methods*; D000328:Adult; D000368:Aged; D016063:Blood Loss, Surgical; D015992:Body Mass Index; D005260:Female; D006801:Humans; D007327:Insufflation; D007564:Japan; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000209:etiology; D017060:Patient Satisfaction; D013997:Time Factors; D047368:Tumor Burden