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Ces Urol 2016; 20(1): 10–12
VIDEO
Methods
: Between 3/2012 and 12/2015, 46 lap‑
aroscopic adrenal surgeries were performed. In 24
(52.2%), a LESS approach was chosen. Indications
were non-complicated cases (= BMI<30, tumour
≤7cm, non-malignant aetiology, no previous sur‑
gery) with very rare exceptions. All LESS were done
by one surgeon. Standard equipment was a 10 mm
rigid 0°camera, Triport+®, one pre-bent grasper, seal‑
ing instrument (LigaSure 5 mm Blunt Tip 37 mm®).
The approach was transperitoneal pararectal in all
cases except in one slimmanwhere a transumbilical
approach was chosen. Peritoneum and Gerota’s fas‑
cia were openedwith LigaSure (LS), adrenal veinwas
dissected with Hem-o-lok™ lockable clips size ML or
with LS in smaller veins. The whole adrenal gland
was liberated with LS. Specimen was extracted in
Endocatch® bag Gold under control of a5 mm 0°
camera (to liberate a 10mmport for bag). The defect
of abdominal wall was closed without drainage.
Three patients with LESS were excluded (two partial
AE only, one adrenal cancer with rapid progression
which was converted to SLAE and then to open
surgery). These 21 LESS-AE are assessed in detail in
the results. Two videos are presented, LESS-AE on
both sides, left side transumbilical approach.
Results
: Left side in 18 (85.7%) cases. In 8 cases
(among first 9 cases) of LESS-AE, a 3 mm port was
added to elevate the liver/spleen. Mean parame‑
ters: maximal tumour diameter 43±17 (8–85), time
of surgery 58±15 (32–95) min, blood loss 27.1±38.4
(0–100) ml, BMI 27.1±3.8 (18.5–34.0), discharge from
hospital 5.3±1.6 (3–10) day. Therewere two complica‑
tions: Clavien grade 1. Histology: 12 adenomas, three
nodular hyperplasia, two pheochromocytoma, two
aneurysmatic cysts, twomalignant tumours (heman‑
giopericytoma and metastasis of ovarian cancer).
Conclusions
: Based on our data, LESS is a feasi‑
ble and alternative method for AE, but only in very
well selected cases: slimmer patients, uncomplicat‑
ed tumour, mainly left side. Subjectively assessed:
The procedure should be performed by an experi‑
enced surgeon since intraoperative complications
during LESS are more difficult to handle/manage
compared to SLAE. The benefit for patients from
LESS approach is questionable and was not inves‑
tigated/proved at this study.
KEY WORDS
Adrenal tumour, adrenalectomy, laparoscopy, LESS.
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