Skip to main content
SpringerLink
Log in

Laparoendoscopic single-site adrenalectomy versus conventional laparoscopic adrenalectomy: a comparison of surgical outcomes and an analysis of a single surgeon’s learning curve

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

Conventional laparoscopic adrenalectomy (LA) is the gold standard procedure for benign adrenal tumors. Laparoendoscopic single-site adrenalectomy (LESS-A) has been developed as an extension of standard laparoscopic minimally invasive procedures.

Methods

This retrospective study compared the first experience of one surgeon with 70 LESS-A to 140 LA cases with respect to evaluating the influence of the inexperience on surgical outcomes and to assess this surgeon’s learning curve for LESS-A.

Results

Age, gender, BMI, percentage of patients with prior abdominal surgery, tumor laterality, and tumor size were all comparable between the two groups. There were no statistically significant differences in any surgical outcomes, including mean operative time, pneumoperitoneum time, estimated blood loss, transfusion requirements, hemoglobin decrease at postoperative day 1, analgesic requirements, postoperative day of oral intake, conversion rate, or morbidity between the two groups. The one exception was hospital stay. There were no mortalities or reoperations in either group. The morbidity rates in the LESS-A group and LA group were 4.2 and 6.4 %, respectively (p = 0.528). LESS-A appears to have a steep learning curve and the operative time of the initial 70 cases decreased markedly and remained stable when the experience level exceeded 12 cases. There was no morbidity or conversion in these first 12 LESS-A cases. Multiple regression analysis revealed that surgeon experience (p = 0.008) and tumor size (p = 0.001) were independent predictors of prolonged operative time.

Conclusions

Surgical outcomes of LESS-A were equivalent to those of LA without compromising safety. The introduction of LESS-A at our hospital was smooth and safe. While the indication for LESS-A has been controversial, LESS-A was a useful procedure, especially for cases in which cosmesis is of paramount importance.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Gagner M, Lacroix A, Bolte E (1992) Laparoscopic adrenalectomy in Cushing’s syndrome and pheochromocytoma. N Engl J Med 327:1033

    Article  PubMed  CAS  Google Scholar 

  2. Merseburger AS, Herrmann TR, Shariat SF, Kyriazis I, Nagele U, Traxer O, Liatsikos EN (2013) EAU guidelines on robotic and single-site surgery in urology. Eur Urol 64:277–291

    Article  PubMed  Google Scholar 

  3. Greco F, Cindolo L, Autorino R, Micali S, Stein RJ, Bianchi G, Fanizza C, Schips L, Fornara P, Kaouk J (2012) Laparoendoscopic single-site upper urinary tract surgery: assessment of postoperative complications and analysis of risk factors. Eur Urol 61:510–516

    Article  PubMed  Google Scholar 

  4. Greco F, Wagner S, Hoda MR, Weigand K, Inferrera A, Fornara P (2011) Single-portal access laparoscopic radical nephrectomy for renal cell carcinoma in transplant patients: the first experience. Eur Urol 59:1060–1064

    Article  PubMed  Google Scholar 

  5. Autorino R, Cadeddu JA, Desai MM, Gettman M, Gill IS, Kavoussi LR, Lima E, Montorsi F, Richstone L, Stolzenburg JU, Kaouk JH (2011) Laparoendoscopic single-site and natural orifice transluminal endoscopic surgery in urology: a critical analysis of the literature. Eur Urol 59:26–45

    Article  PubMed  Google Scholar 

  6. Kaouk JH, Autorino R, Kim FJ, Han DH, Lee SW, Yinghao S, Cadeddu JA, Derweesh IH, Richstone L, Cindolo L, Branco A, Greco F, Allaf M, Sotelo R, Liatsikos E, Stolzenburg JU, Rane A, White WM, Han WK, Haber GP, White MA, Molina WR, Jeong BC, Lee JY, Linhui W, Best S, Stroup SP, Rais-Bahrami S, Schips L, Fornara P, Pierorazio P, Giedelman C, Lee JW, Stein RJ, Rha KH (2011) Laparoendoscopic single-site surgery in urology: worldwide multi-institutional analysis of 1076 cases. Eur Urol 60:998–1005

    Article  PubMed  Google Scholar 

  7. Hirano D, Minei S, Yamaguchi K, Yoshikawa T, Hachiya T, Yoshida T, Ishida H, Takimoto Y, Saitoh T, Kiyotaki S, Okada K (2005) Retroperitoneoscopic adrenalectomy for adrenal tumors via a single large port. J Endourol 19:788–792

    Article  PubMed  Google Scholar 

  8. Jeong BC, Park YH, Han DH, Kim HH (2009) Laparoendoscopic single-site and conventional laparoscopic adrenalectomy: a matched case-control study. J Endourol 23:1957–1960

    Article  PubMed  Google Scholar 

  9. Shi TP, Zhang X, Ma X, Li HZ, Zhu J, Wang BJ, Gao JP, Cai W, Dong J (2011) Laparoendoscopic single-site retroperitoneoscopic adrenalectomy: a matched-pair comparison with the gold standard. Surg Endosc 25:2117–2124

    Article  PubMed  PubMed Central  Google Scholar 

  10. Wang L, Liu B, Wu Z, Yang Q, Chen W, Sheng H, Xu Z, Xiao L, Wang C, Sun Y (2012) Comparison of single-surgeon series of transperitoneal laparoendoscopic single-site surgery and standard laparoscopic adrenalectomy. Urology 79:577–583

    Article  PubMed  Google Scholar 

  11. Lin VC, Tsai YC, Chung SD, Li TC, Ho CH, Jaw FS, Tai HC, Yu HJ (2012) A comparative study of multiport versus laparoendoscopic single-site adrenalectomy for benign adrenal tumors. Surg Endosc 26:1135–1139

    Article  PubMed  Google Scholar 

  12. Kwak HN, Kim JH, Yun JS, Son BH, Chung WY, Park YL, Park CH (2011) Conventional laparoscopic adrenalectomy versus laparoscopic adrenalectomy through mono port. Surg Laparosc Endosc Percutan Tech 21:439–442

    Article  PubMed  Google Scholar 

  13. Walz MK, Groeben H, Alesina PF (2010) Single-access retroperitoneoscopic adrenalectomy (SARA) versus conventional retroperitoneoscopic adrenalectomy (CORA): a case-control study. World J Surg 34:1386–1390

    Article  PubMed  Google Scholar 

  14. Tunca F, Senyurek YG, Terzioglu T, Iscan Y, Tezelman S (2012) Single-incision laparoscopic adrenalectomy. Surg Endosc 26:36–40

    Article  PubMed  Google Scholar 

  15. Vidal O, Astudillo E, Valentini M, Ginesta C, Garcia-Valdecasas JC, Fernandez-Cruz L (2012) Single-incision transperitoneal laparoscopic left adrenalectomy. World J Surg 36:1395–1399

    Article  PubMed  Google Scholar 

  16. Ishida M, Miyajima A, Takeda T, Hasegawa M, Kikuchi E, Oya M (2013) Technical difficulties of transumbilical laparoendoscopic single-site adrenalectomy: comparison with conventional laparoscopic adrenalectomy. World J Urol 31:199–203

    Article  PubMed  Google Scholar 

  17. Miyajima A, Hattori S, Maeda T, Hasegawa M, Takeda T, Kikuchi E, Asanuma H, Nakagawa K, Oya M (2012) Transumbilical approach for laparo-endoscopic single-site adrenalectomy: initial experience and short-term outcome. Int J Urol 19:331–335

    Article  PubMed  Google Scholar 

  18. Higashihara E, Tanaka Y, Horie S, Aruga S, Nutahara K, Minowada S, Aso Y (1993) Laparoscopic adrenalectomy: the initial 3 cases. J Urol 149:973–976

    PubMed  CAS  Google Scholar 

  19. Clavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD, de Santibanes E, Pekolj J, Slankamenac K, Bassi C, Graf R, Vonlanthen R, Padbury R, Cameron JL, Makuuchi M (2009) The Clavien–Dindo classification of surgical complications: five-year experience. Ann Surg 250:187–196

    Article  PubMed  Google Scholar 

  20. Hu Q, Gou Y, Sun C, Xu K, Xia G, Ding Q (2013) A systematic review and meta-analysis of current evidence comparing laparoendoscopic single-site adrenalectomy and conventional laparoscopic adrenalectomy. J Endourol 27:676–683

    Article  PubMed  Google Scholar 

  21. Yuge K, Miyajima A, Hasegawa M, Miyazaki Y, Maeda T, Takeda T, Takeda A, Miyashita K, Kurihara I, Shibata H, Kikuchi E, Oya M (2010) Initial experience of transumbilical laparoendoscopic single-site surgery of partial adrenalectomy in patient with aldosterone-producing adenoma. BMC Urol 10:1471–2490

    Article  Google Scholar 

  22. Hattori S, Miyajima A, Maeda T, Hasegawa M, Takeda T, Kosaka T, Kikuchi E, Nakagawa K, Oya M (2013) Does laparoendoscopic single-site adrenalectomy increase surgical risk in patients with pheochromocytoma? Surg Endosc 27:593–598

    Article  PubMed  Google Scholar 

  23. Park SK, Olweny EO, Best SL, Tracy CR, Mir SA, Cadeddu JA (2011) Patient-reported body image and cosmesis outcomes following kidney surgery: comparison of laparoendoscopic single-site, laparoscopic, and open surgery. Eur Urol 60:1097–1104

    Article  PubMed  Google Scholar 

  24. Inoue S, Ikeda K, Kobayashi K, Kajiwara M, Teishima J, Matsubara A (2014) Patient-reported satisfaction and cosmesis outcomes following laparoscopic adrenalectomy: laparoendoscopic single-site adrenalectomy vs. conventional laparoscopic adrenalectomy. Can Urol Assoc J 8(1–2):E20–E25

    PubMed  PubMed Central  Google Scholar 

  25. Golkar FC, Ross SB, Sperry S, Vice M, Luberice K, Donn N, Morton C, Hernandez JM, Rosemurgy AS (2012) Patients’ perceptions of laparoendoscopic single-site surgery: the cosmetic effect. Am J Surg 204:751–761

    Article  PubMed  Google Scholar 

  26. Fornara P, Doehn C, Seyfarth M, Jocham D (2000) Why is urological laparoscopy minimally invasive? Eur Urol 37:241–250

    Article  PubMed  CAS  Google Scholar 

  27. Elfenbein DM, Scarborough JE, Speicher PJ, Scheri RP (2013) Comparison of laparoscopic versus open adrenalectomy: results from American College of Surgeons-National Surgery Quality Improvement Project. J Surg Res 184:216–220

    Article  PubMed  Google Scholar 

  28. Tugcu V, Ilbey YO, Sonmezay E, Aras B, Tasci AI (2013) Laparoendoscopic single-site versus conventional transperitoneal laparoscopic pyeloplasty: a prospective randomized study. Int J Urol 20:1112–1117

    Article  PubMed  Google Scholar 

  29. Humphrey JE, Canes D (2012) Transumbilical laparoendoscopic single-site surgery in urology. Int J Urol 19:416–428

    Article  PubMed  Google Scholar 

  30. Guerrieri M, Campagnacci R, De Sanctis A, Baldarelli M, Coletta M, Perretta S (2008) The learning curve in laparoscopic adrenalectomy. J Endocrinol Invest 31:531–536

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgments

The authors wish to thank Dr. Takayuki Abe, PhD for his valuable assistance with the statistical analyses.

Disclosures

Drs. Yosuke Hirasawa, Akira Miyajima, Seiya Hattori, Kazutoshi Miyashita, Isao Kurihara, Hirotaka Shibata, Eiji Kikuchi, Ken Nakagawa, and Mototsugu Oya have no conflicts of interest or financial ties to disclose.

Author information

Authors and Affiliations

  1. Department of Urology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan

    Yosuke Hirasawa, Akira Miyajima, Seiya Hattori, Eiji Kikuchi, Ken Nakagawa & Mototsugu Oya

  2. Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan

    Kazutoshi Miyashita & Isao Kurihara

  3. Department of Endocrinology, Metabolism, Rheumatology and Nephrology, Faculty of Medicine, Oita University, Oita, Japan

    Hirotaka Shibata

Authors
  1. Yosuke Hirasawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Akira Miyajima
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Seiya Hattori
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Kazutoshi Miyashita
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Isao Kurihara
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Hirotaka Shibata
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Eiji Kikuchi
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Ken Nakagawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Mototsugu Oya
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Akira Miyajima.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Hirasawa, Y., Miyajima, A., Hattori, S. et al. Laparoendoscopic single-site adrenalectomy versus conventional laparoscopic adrenalectomy: a comparison of surgical outcomes and an analysis of a single surgeon’s learning curve. Surg Endosc 28, 2911–2919 (2014). https://doi.org/10.1007/s00464-014-3553-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-014-3553-3

Keywords

Search

Navigation