Retroperitoneal laparoendoscopic single-site adrenalectomy for pheochromocytoma: our single center experiences

To evaluate the feasibility and safety of retroperitoneal laparoendoscopic single-site adrenalectomy for pheochromocytoma (LESS-PHEO) and summarize our initial experience.

Between June 2009 and June 2013, 21 patients with adrenal pheochromocytoma underwent adrenalectomy by means of LESS-PHEO in our department. Fifty-three patients with pheochromocytoma underwent conventional retrolaparoscopic adrenalectomy (RLAP-PHEO) between March 2001 and June 2013, of whom 42 were selected as a control group for a retrospective serial case-control analysis (1:2 matched-pair cohort). In the operation, the retroperitoneal space was created and dilated by blunt finger dissection and the pneumoperitoneal pressure was maintained below 10 mm Hg. As the first step, ligation of the adrenal central vein was performed. Intraoperative hemodynamic parameters, operating time, estimated blood loss, transfusion requirement, incidence of perioperative complications, visual analog pain scale (VAPS) score, time to resumption of oral intake and ambulation, and postoperative hospitalization were compared between the groups.

All the operations were technically successful, without reoperations or conversion to open procedures. The 24-hour postoperative VAPS score was lower in the LESS-PHEO group than in the control group (5 vs 7; p<0.001). Despite a longer median operative time (167.4 minutes vs 125.5 minutes; p<0.001), the patients in the LESS-PHEO group resumed oral intake sooner (1 day vs 2 days; p<0.001), ambulated sooner (1 day vs 2 days; p<0.001), and were discharged earlier (4 days vs 7 days; p<0.001). No perioperative complications occurred in both the groups. No statistically significant differences in hemodynamic parameters or estimated blood loss were found between the groups.

Although more training and practice are needed to shorten its operative time, LESS-PHEO, as performed by an experienced laparoscopic urologist, is a feasible and safe procedure associated with less postoperative pain and faster recovery.