title: Laparoendoscopic single-site surgery adrenalectomy - own experience and matched case-control study with standard laparoscopic adrenalectomy.
abstract: BACKGROUND
  At our institution, laparoendoscopic single-site surgery (LESS) has been established as a technique for laparoscopic nephrectomy since 2011, and since 2012 in selected cases for adrenalectomy (AE) as well.
  
  
  OBJECTIVE
  To compare LESS AE with standard laparoscopic AE (SLAE).
  
  
  METHODS
  Between 3/2012 and 7/2014, 35 adrenalectomies were performed. In 18 (51.4%), a LESS approach was chosen. Indications were strictly non-complicated cases (body mass index (BMI) < 34 kg/m(2), tumour ≤ 7 cm, non-malignant aetiology, no previous surgery). All LESS procedures were done by one surgeon. Standard equipment was a 10 mm rigid 0° camera, Triport+, one pre-bent grasper, and a sealing instrument. The approach was pararectal in all cases except one (transumbilical in a slim man). Three patients with LESS were excluded (2 partial AEs only, one adrenal cancer converted to SLAE and then to open surgery). These 15 LESS AE procedures were compared to 15 SLAEs with similar characteristics chosen among 54 SLAEs performed in the period 1/2008-2/2012.
  
  
  RESULTS
  In 8 cases (53.3%) of LESS AE, a 3 mm port was added to elevate the liver/spleen. Mean parameters of LESS AE vs. SLAE (Wilcoxon test): maximal tumour diameter 43.7 mm vs. 36.1 mm (p = 0.28), time of surgery 63.3 min vs. 55.3 min (p = 0.22), blood loss 38.0 ml vs. 38.0 ml (p = 0.38), BMI 26.9 kg/m(2) vs. 28.5 kg/m(2) (p = 0.13), discharge from hospital 5.4 days vs. 3.9 days (p = 0.038). There were no complications in either group.
  
  
  CONCLUSIONS
  The LESS AE is feasible in selected cases, especially small left-sided tumours in thin patients with no history of previous abdominal operations, but requires an additional port in half of the cases.
authors.affiliation: Department of Urology, Faculty Hospital and Faculty of Medicine Pilsen, Pilsen, Czech Republic ; Faculty Hospital and Faculty of Medicine Pilsen, Pilsen, Czech Republic.
authors.forename: Milan
authors.initials: M
authors.lastname: Hora
authors.affiliation: Department of Urology, Faculty Hospital and Faculty of Medicine Pilsen, Pilsen, Czech Republic ; Faculty Hospital and Faculty of Medicine Pilsen, Pilsen, Czech Republic.
authors.forename: Tomáš
authors.initials: T
authors.lastname: Ürge
authors.affiliation: Department of Urology, Faculty Hospital and Faculty of Medicine Pilsen, Pilsen, Czech Republic.
authors.forename: Petr
authors.initials: P
authors.lastname: Stránský
authors.affiliation: Department of Urology, Faculty Hospital and Faculty of Medicine Pilsen, Pilsen, Czech Republic ; Faculty Hospital and Faculty of Medicine Pilsen, Pilsen, Czech Republic.
authors.forename: Ivan
authors.initials: I
authors.lastname: Trávníček
authors.affiliation: Department of Urology, Faculty Hospital and Faculty of Medicine Pilsen, Pilsen, Czech Republic ; Faculty Hospital and Faculty of Medicine Pilsen, Pilsen, Czech Republic.
authors.forename: Tomáš
authors.initials: T
authors.lastname: Pitra
authors.affiliation: Department of Urology, Faculty Hospital and Faculty of Medicine Pilsen, Pilsen, Czech Republic ; Faculty Hospital and Faculty of Medicine Pilsen, Pilsen, Czech Republic.
authors.forename: Kristýna
authors.initials: K
authors.lastname: Kalusová
authors.affiliation: Faculty Hospital and Faculty of Medicine Pilsen, Pilsen, Czech Republic.
authors.forename: Olga
authors.initials: O
authors.lastname: Dolejšová
authors.affiliation: Department of Pathology, National University Health System, Singapore.
authors.forename: Fredrik
authors.initials: F
authors.lastname: Petersson
authors.affiliation: Department of Endocrinology, Faculty Hospital and Faculty of Medicine Pilsen, Pilsen, Czech Republic.
authors.forename: Michal
authors.initials: M
authors.lastname: Krčma
authors.affiliation: Department of Urology, Jagiellonian University Medical College, Krakow, Poland.
authors.forename: Piotr
authors.initials: P
authors.lastname: Chlosta
keywords: adrenal tumour; adrenalectomy; laparoendoscopic single-site surgery; laparoscopy