Laparoendoscopic single-site retroperitoneoscopic adrenalectomy: bilateral step-by-step technique

Area of Science:

• Minimally Invasive Surgery
• Surgical Oncology
• Endourology

Background:

• Laparoscopic adrenalectomy is the standard for small benign adrenal tumors.
• Accessing adrenal glands in the retroperitoneum presents surgical challenges.
• Laparoendoscopic single-site posterior retroperitoneoscopic adrenalectomy (LESS-PRA) aims to reduce trauma and improve cosmesis.

Purpose of the Study:

• To detail the step-by-step technique of LESS-PRA.
• To compare perioperative outcomes of LESS-PRA with 3-port lateral retroperitoneoscopic adrenalectomy (LRA).

Main Methods:

• Retrospective review of 100 patients with adrenal tumors (<4 cm) from February 2008 to January 2016.
• 20 patients underwent LESS-PRA, and 80 patients underwent LRA.
• Comparison of demographic data, perioperative outcomes, and cosmetic satisfaction (visual analog scale).

Main Results:

• LESS-PRA showed lower estimated blood loss (50 vs. 100 ml) and shorter analgesic time (24 vs. 40 h) compared to LRA.
• LESS-PRA had a longer operative time (100 vs. 60 min) but superior cosmetic satisfaction (9.5 vs. 8.6).
• No significant differences in complications or hospital stay; no conversions to open surgery were required.

Conclusions:

• LESS-PRA demonstrates comparable functional and perioperative outcomes to LRA for small adrenal tumors.
• LESS-PRA offers advantages in reduced blood loss, analgesic duration, and improved cosmetic outcomes.
• The technique is a viable alternative, balancing operative time with patient benefits.