title: Patient-reported postoperative pain, body image, and cosmetic satisfaction after transumbilical laparoendoscopic single-site adrenalectomy.
abstract: BACKGROUND
  Laparoendoscopic single-site surgery is a recently innovated urologic surgical procedure. Transumbilical laparoendoscopic single-site adrenalectomy (LESS-A) is technically safe and feasible in patients with benign adrenal tumors. To improve patient counseling and informed consent, we evaluated patient-reported postoperative pain, body image, and cosmetic satisfaction after transumbilical LESS-A.
  
  
  METHODS
  We reviewed 24 patients who underwent transumbilical LESS-A and assessed their operative and esthetic outcomes and incisional pain. Incisional pain was evaluated using a 10-point visual analog scale, and the body image and cosmetic satisfaction were measured using a questionnaire that included a body image scale (range, 5-20 points) and a cosmetic scale (range, 3-24 points).
  
  
  RESULTS
  Pure LESS-A was performed on 10 patients using a multichannel port; an additional 5-mm trocar was used in two obese patients. Supplementary to the single-incision approach, one or two 3-mm ports were used in 12 patients. The mean operative time was 203 min; the mean blood loss was 41 mL. The mean pain visual analog scale scores on postoperative days 1, 3, and 7 were 3.5, 2.2 (P = 0.012), and 1.5 points (P = 0.018), respectively. The mean body image scale and cosmetic scale scores indicating wound satisfaction 1 month after the surgery were 20 and 22 points, respectively. Although one patient had liver injury during surgery, the postoperative course during the 3-month follow-up was uneventful.
  
  
  CONCLUSIONS
  Transumbilical LESS-A confers less postoperative pain and better cosmetic satisfaction than conventional laparoscopic adrenalectomy. Therefore, this procedure could potentially become a standard treatment option for benign adrenal tumors.
authors.affiliation: Department of Urology, Oita University Faculty of Medicine, Yufu, Japan.
authors.forename: Takeo
authors.initials: T
authors.lastname: Nomura
authors.affiliation: Department of Urology, Oita University Faculty of Medicine, Yufu, Japan.
authors.forename: Kohei
authors.initials: K
authors.lastname: Takei
authors.affiliation: Department of Urology, Oita University Faculty of Medicine, Yufu, Japan.
authors.forename: Satoki
authors.initials: S
authors.lastname: Abe
authors.affiliation: Department of Urology, Koseiren Tsurumi Hospital, Beppu, Japan.
authors.forename: Yuko
authors.initials: Y
authors.lastname: Fukuda
authors.affiliation: Department of Urology, Oita University Faculty of Medicine, Yufu, Japan.
authors.forename: Naoyuki
authors.initials: N
authors.lastname: Yamanaka
authors.affiliation: Department of Urology, Oita University Faculty of Medicine, Yufu, Japan.
authors.forename: Shinya
authors.initials: S
authors.lastname: Sejiyama
authors.affiliation: Department of Urology, Oita University Faculty of Medicine, Yufu, Japan.
authors.forename: Mutsushi
authors.initials: M
authors.lastname: Yamasaki
authors.affiliation: Department of Urology, Oita University Faculty of Medicine, Yufu, Japan.
authors.forename: Tadamasa
authors.initials: T
authors.lastname: Shibuya
authors.affiliation: Department of Urology, Oita University Faculty of Medicine, Yufu, Japan.
authors.forename: Tadasuke
authors.initials: T
authors.lastname: Ando
authors.affiliation: Department of Urology, Oita University Faculty of Medicine, Yufu, Japan.
authors.forename: Ken-Ichi
authors.initials: KI
authors.lastname: Mori
authors.affiliation: Department of Urology, Koseiren Tsurumi Hospital, Beppu, Japan.
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Sumino
authors.affiliation: Department of Urology, Oita University Faculty of Medicine, Yufu, Japan.
authors.forename: Fuminori
authors.initials: F
authors.lastname: Sato
authors.affiliation: Department of Urology, Oita University Faculty of Medicine, Yufu, Japan.
authors.forename: Hiromitsu
authors.initials: H
authors.lastname: Mimata
mesh_terms: D000310:Adrenal Gland Neoplasms / Q000601:surgery*; D000315:Adrenalectomy / Q000379:methods*; D000328:Adult; D000368:Aged; D001828:Body Image; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D010149:Postoperative Pain / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control*; D000071066:Patient Reported Outcome Measures; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D011446:Prospective Studies; D012189:Retrospective Studies
keywords: Cosmesis; LESS-adrenalectomy; pain