Needlescopic-assisted laparoendoscopic single-site adrenalectomy.
OBJECTIVE
Our objective was to compare the perioperative parameters of needle-assisted and conventional laparoendoscopic single-site adrenalectomy (LESS-A).


METHODS
We compared 23 patients undergoing needle-assisted LESS-A with 29 patients undergoing conventional LESS-A at Hiroshima University Hospital between November 2009 and February 2014. Needle-assisted LESS-A was performed using a MiniLap instrument (Stryker, San Jose, CA, USA). We used this instrument to protectively retract the liver at the right side of the tumor and the spleen at the left side by grasping with a Securea endoscopic surgical spacer (Hogy Medical Co., Ltd., Tokyo, Japan). Various parameters including insufflation time, estimated blood loss, pain scale, resumption of oral intake, transfusion rate, and complications were analyzed using the Mann-Whitney U test.


RESULTS
In all cases, LESS-A was completed successfully with no major intraoperative complications. Patients in both treatment groups had similar age, body mass index, sex, and laterality. Significantly, needle-assisted LESS-A was performed using the transumbilical approach rather than the subcostal approach. The insufflation time of the needle-assisted LESS-A was shorter than that of the conventional LESS-A (p = 0.0335). No patients required intraoperative or postoperative blood transfusions. Retrospective design and the small sample size are main limitations of this study.


CONCLUSIONS
Needle-assisted LESS-A was performed safely and in a manner that mitigated many of the difficulties of LESS surgery.
Department of Urology, Hiroshima University Graduate School of Biomedical Sciences, Hiroshima, Japan. Electronic address: inosyogo@hiroshima-u.ac.jp.
Shogo
S
Inoue
Department of Urology, Hiroshima University Graduate School of Biomedical Sciences, Hiroshima, Japan.
Mitsuru
M
Kajiwara
Department of Urology, Hiroshima University Graduate School of Biomedical Sciences, Hiroshima, Japan.
Jun
J
Teishima
Department of Urology, Hiroshima University Graduate School of Biomedical Sciences, Hiroshima, Japan.
Akio
A
Matsubara
D000307:Adrenal Gland Diseases / Q000473:pathology / Q000601:surgery*; D000315:Adrenalectomy / Q000295:instrumentation*; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000295:instrumentation*; D008297:Male; D008875:Middle Aged; D009339:Needles; D012189:Retrospective Studies
adrenal tumor; laparoendoscopic single-site surgery; needlescopic surgery