title: Laparoendoscopic single-site retroperitoneoscopic adrenalectomy: bilateral step-by-step technique.
abstract: Laparoscopic adrenalectomy is the gold standard surgical approach for small benign adrenal tumors [1]. Several surgical approaches were developed in order to overcome the difficulty to access the adrenal glands, located in the upper retroperitoneum space [2-4]. Laparoendoscopic single-site posterior retroperitoneoscopic adrenalectomy (LESS-PRA) is an emerging technique that reduced the multiple trocar-related trauma and improved cosmetic outcomes while minimizing postoperative morbidity [5-8]. The aim of this study was to describe our step-by-step technique for LESS-PRA and to compare our perioperative outcomes with the conventional 3-port lateral retroperitoneoscopic adrenalectomy (LRA).
  
  
  
  A retrospective review was carried out from February 2008 to January 2016 that included 100 patients with adrenal tumors smaller than 4 cm. Study exclusion criteria were defined as tumor size greater than 4 cm, patients older than 80 years, and body mass index (BMI) greater than 40. A total of 20 patients underwent LESS-PRA and 80 patients underwent 3-port lateral retroperitoneoscopic laparoscopic adrenalectomy. Patient's demographic data and perioperative outcomes were compared and statistically analyzed. The cosmetic satisfaction was evaluated with a visual analog scale.
  
  
  
  Estimated blood loss was higher in LRA (100 vs. 50 ml; p = 0.35). Operative time was longer in LESS-PRA than LRA (100.0 vs. 60 min; p < 0.001). Analgesic time necessary for LRA was longer than LESS-PRA (40 vs. 24 h; p < 0.001). Cosmetic satisfaction score was higher in LESS-PRA (9.5 vs. 8.6; p = 0.03). There were no significant differences in perioperative complications and length of hospital stay. No conversion to conventional laparoscopic or open surgery was necessary.
  
  
  
  LESS-PRA presented comparable functional and perioperative outcomes to LRA for small adrenal tumors. Although LESS-PRA was associated with longer operative time, it provided inferior estimated blood loss, analgesic time, and improved cosmetic satisfaction.
authors.affiliation: Urology Division, ABC Medical School, Santo André, SP, Brazil.
authors.forename: Marcos-Tobias
authors.initials: MT
authors.lastname: Machado
authors.affiliation: Urology Division, Arnaldo Vieira de Carvalho Cancer Institute- IAVC, São Paulo, SP, Brazil.
authors.forename: Igor
authors.initials: I
authors.lastname: Nunes-Silva
authors.affiliation: Institute of Urology, ABC Medical School, Santo André, Brazil. Eduardo.fcosta42@gmail.com.
authors.forename: Eduardo Fernandes
authors.initials: EF
authors.lastname: da Costa
authors.affiliation: ABC Medical School, Santo André, Brazil.
authors.forename: Alexandre Kyoshi
authors.initials: AK
authors.lastname: Hidaka
authors.affiliation: Urology Division, Hospital de Câncer de Barretos, Barretos, SP, Brazil.
authors.forename: Eliney Ferreira
authors.initials: EF
authors.lastname: Faria
authors.affiliation: Urology Division, Arnaldo Vieira de Carvalho Cancer Institute- IAVC, São Paulo, SP, Brazil.
authors.forename: Hamilton
authors.initials: H
authors.lastname: Zampolli
authors.affiliation: Urology Division, ABC Medical School, Santo André, SP, Brazil.
authors.forename: Carlos Alberto
authors.initials: CA
authors.lastname: Bezerra
mesh_terms: D000310:Adrenal Gland Neoplasms / Q000601:surgery*; D000315:Adrenalectomy / Q000379:methods*; D000328:Adult; D000368:Aged; D000700:Analgesics / Q000627:therapeutic use; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D010147:Pain Measurement; D012187:Retroperitoneal Space / Q000601:surgery; D012189:Retrospective Studies; D014741:Video Recording
chemical_list: D000700:Analgesics
keywords: Adrenalectomy; LESS; Laparoendoscopic; Laparoscopy; Single-port surgery; Single-site surgery