A Comparative Study Of Retroperitoneal Laparoendoscopic Single-site Surgery(LESS) And Conventional Laparoscopic Adrenalectomy

ObjectiveTo evaluate the clinical efficacy and explore clinical value on Laparoendoscopic Single-site Surgery(LESS) in retrospective comparision of conventional Laparoscopic Retroperitoneal AdrenalectomyMethodsBetween march2010and December2011,a total of136patients with benign adrenal tumors were involved.64patients underwent LESS Retroperitoneal Adrenalectomy(Group A),Another72patients with benign adrenal tumors served as a conventional multiport laparoscopic Retroperitoneal adrenalectomy(Group B),The following parameters were compared retrospectively between the two groups:Age,gender,BMI,the sides of operation,Tumor size,Diagnosis,operative time,intraoperative estimated blood loss,incision length,perioperative complications,drainage Volume,time to anal exsufflation,time to ambulation,time of postoperative drainage, postoperative pain Verbal rating scale (VRS),analgesic requirement, postoperative hospital stay. ResultsAll operations of the two groups were performed successfully. None of LESS Group experienced conversion to conventional Laparoscopic surgery,One patient need an additional5mm trocar for injured peritoneum.In LESS Group and conventional Laparoscopic Group, mean operative time was73.28±28.563min vs64.43±22.103min,mean intraoperative estimated blood loss was18.98±7.940mL vs17.80±8.007mL,mean incision length was2.68±0.244cm vs5.02±0.406cm, drainage Volume was30.63±14.015mL vs32.08±10.200mL,mean time to anal exsuflation was2.21±0.686d vs2.83±0.811d, time to ambulation was3.25±0.959d vs3.71±0.830d,2patients vs9patients used postoperation analgesia, Verbal rating scale was3699.00vs5481.00,mean time of postoperative drainage was3.79±0.876d vs4.03±0.878d,postoperative hospital stay was5.63±1.709d vs6.08±1.811d.In LESS Group,4patients with injured peritoneum,6ones with hypercapnia,8ones subcutaneous emphysema,In conventional Laparoscopic Group,2patient with injured peritoneum,9ones with hypercapnia,11ones subcutaneous emphysema,1patient with incision infection.The patients were followed up for3-24months.B-ultrasound, IVU or MRI showed no Recurrent tumor.Results showed that there were no significant differences between the2groups in terms of age,gender,BMI,the sides of operation,Tumor size,Diagnosis (P>0.05);there were significant differences between the2groups in terms of length of incision, time to anal exsufflation,cases of postoperation analgesia,postoperative pain Verbal rating scale (VRS),time to ambulation(P<0.05); no significant differences between the2groups in terms of the operative time, intraoperative estimated blood loss,perioperative complications, drainage Volume,time of postoperative drainagea, postoperative hospital stay(P>0.05).Conclusions1. Retroperitoneal Laparoendoscopic Single-site Surgery(LESS) adrenalectomy was a safe and effective procedure2.Because of the technical difficulties of Retroperitoneal LESS, intensive experience with performing traditional retroperitoneal laparoscopy may be helpful to decrease the operative time and shorten the learning curve when performing LESS.3.Retroperitoneal LESS adrenalectomy presents a better cosmetic outcome.4.Retroperitoneal LESS adrenalectomy has the advantages of less postoperative pain and quicker postoperative recovery5.The retroperitoneal approach is more familiar to the urologic surgeon and may be an initial option to perform LESS.