Single-access retroperitoneal adrenalectomy

To report the first case in our country of a single access--adrenalectomy with lateral retroperitoneal approach by using SILS port and to evaluate the feasibility and safety of this new technique.

A 50-year-old man presented with 38 mm right adrenal incidentaloma, functionally nonactive and without radiologic characteristics suggestive of a malignant lesion, discovered on abdominal computed tomography for nephrolithiasis. The single access adrenalectomy was attempted with multichannel SILS port (Covidien), inserted through a 3 cm transverse incision at the tip of rib XII on the right side.

The single access retroperitoneal adrenalectomy (SARA) was successfully completed without any intraoperative complications. An additional lateral 5-mm port was needed for retraction of the kidney and for tubular drain in the end stage of the surgery. The operating time was 120 minutes with 40 mL of blood loss. Postoperative recovery was uneventful. The patient was discharged from the hospital on the second postoperative day. Pathologic examination confirmed cortical adenoma of the adrenal grand. No morbidity within one month of follow-up, and excellent cosmetic results.

This is the first case of a single access retroperitoneal adrenalectomy (SARA) by using SILS port was performed in our country. Based on our primary experience, we believe that SARA is a safe and feasible procedure for selected patients with adrenal tumors and when performed by a surgeon experienced in laparoscopic and adrenal surgery. Although initial technical adjustments are inevitable, simplifying the procedure. However, more surgical experience using this technique is required to confirm our initial impressions.