Laparoendoscopic single-site retroperitoneoscopic adrenalectomy compared with conventional laparoscopy and open surgery

Objective Laparoendoscopic single-site surgery (LESS) is a new laparoscopy development that avoids the use of multiple ports and minimizes morbidity. Combined with retroperitoneoscopy, LESS is suitable for adrenalectomy. We compared open, conventional laparoscopic, and LESS-retroperitoneoscopic adrenalectomy (LESS-RA) surgeries for adrenal tumor removal. Furthermore, we analyzed the conventional retroperitoneoscopic adrenalectomy (CRA) and LESS-RA outcomes. Materials and Methods We examined 178 patients who underwent adrenalectomy: 43 by open surgery, 72 by conventional laparoscopy, and 63 by LESS-RA. We analyzed the outcomes of operative time, estimated blood loss (EBL), complications, postoperative convalescence, time to resuming oral intake, analgesics on demand, and hospital stay. Results We found that the open surgery group had a significantly greater mean EBL than the conventional laparoscopy or LESS-RA group (353.1 ± 313.6 mL vs. 62.3 ± 76.9 mL vs. 60.9 ± 64.3 mL, respectively; p < 0.0001). Open surgery was lengthier than LESS-RA. Both hospital stay and time to resuming oral intake were shortest in the LESS-RA group, followed by conventional laparoscopy and open surgery. CRA and LESS-RA did not differ significantly in mean tumor size, operation time, or EBL. However, there were significant differences in postoperative hospital stay length (6.4 ± 3.4 days vs. 3.6 ± 1.3 days, respectively; p < 0.0001), time to resuming oral intake (1.2 ± 0.5 days vs. 0.4 ± 0.5 days, respectively; p < 0.0001), and number of on-demand intravenous or intramuscular analgesics needed (0.5 ± 0.8 ampoules/vial vs. 0.3 ± 0.6 ampoules/vial, respectively; p = 0.0484). Conclusion The standard approach to adrenalectomy recently improved from open to laparoscopic surgery, transperitoneal to retroperitoneal access, and multiple ports to a single port. Here we found that laparoscopic surgery had better intra- and postoperative outcomes than open surgery. Furthermore, patients treated with LESS-RA required less postoperative recovery time and less analgesic use than those treated with CRA.