Laparoendoscopic Single-Site Surgery for Left Adrenalectomy: Standardization of Technique

Abstract

Purpose:

We developed step-by-step standardization of left adrenalectomy using laparoendoscopic single-site surgery (LESS) and evaluated the efficacy and safety of this surgical procedure.

Patients and Methods:

To simplify the procedure, we used a technique that involved handling one straight operating instrument and crossing over another articulated assistant instrument intracorporeally. We classified the reciprocal positions of the two instruments into four types. The surgical procedures were divided into six steps, and we applied one of the four types of position to each step.

Results:

Seven patients with left adrenal tumor underwent LESS by two operators. Five received left total adrenalectomy, one left partial adrenalectomy, and one bilateral total adrenalectomy. Mean operative time was 178 minutes. Blood loss was minimal (≤50 mL), and convalescence was uneventful in all patients.

Conclusions:

Although there is inevitably a learning curve, LESS left adrenalectomy can be safely introduced by beginners using a step-by-step standardized technique.