Sasaki Akira, Nitta Hiroyuki, Otsuka Koki, Nishizuka Satoshi, Baba Shigeaki, Umemura Akira, Koeda Keisuke, Mizuno Masaru, Wakabayashi Go
BMC Urol. 2013 Apr 12;13:21. doi: 10.1186/1471-2490-13-21.
Recent reports have suggested that laparoendoscopic single site (LESS) surgery is technically feasible. The aim of this study was to describe our initial experience with LESS adrenalectomy for benign adrenal tumors, focusing the attention about cosmetic satisfaction and reduction of postoperative pain.
Medical records of consecutive patients undergoing LESS adrenalectomy were analyzed. All procedures were performed through a single multichannel port. Demographic and operative data were assessed. A visual analog scale (VAS) was used with a 10-point scale for an objective assessment of incisional pain and incisional cosmesis.
Between January 2010 and July 2012, 14 consecutive patients with benign adrenal tumors underwent LESS adrenalectomies. Of the planned LESS adrenalectomies, 12 (86%) were completed with a single-port, whereas two required an additional port placement. Mean operating time was 128.1 ± 31.5 min and mean blood loss 10.5 ± 12.1 ml. Mean pain scores using the VAS on postoperative days 1, 3, and 14 were 2.3, 1.0, and 0.3 points, respectively. The rate of analgesic use was also lower within 12 hours after surgery (14%). The patient was highly satisfied with the single small wound procedure, and mean cosmesis scores of postoperative days 3 and 14 were 9.4 and 9.8 points, respectively. The postoperative course was uneventful with no morbidity within one month of follow-up.
LESS adrenalectomy is a safe and technically feasible procedure for patients with benign adrenal tumors, and offers cosmetic benefit and the potential for postoperative pain reduction. However, surgeons with lack of experience as LESS surgery should be comprehended that the assistance of the needlescopic instrument does not compromise the cosmetic outcomes for difficult cases and the obese patients may not always be suitable candidates for pure LESS technique.
近期报告表明，经脐单孔腹腔镜手术（LESS）在技术上是可行的。本研究的目的是描述我们开展LESS肾上腺切除术治疗良性肾上腺肿瘤的初步经验，重点关注美容满意度和术后疼痛减轻情况。
分析连续接受LESS肾上腺切除术患者的病历。所有手术均通过单个多通道端口进行。评估人口统计学和手术数据。采用视觉模拟评分法（VAS），以10分制对切口疼痛和切口美观进行客观评估。
2010年1月至2012年7月，14例连续的良性肾上腺肿瘤患者接受了LESS肾上腺切除术。在计划的LESS肾上腺切除术中，12例（86%）通过单孔完成，而2例需要额外放置一个端口。平均手术时间为128.1±31.5分钟，平均失血量为10.5±12.1毫升。术后第1天、第3天和第14天使用VAS的平均疼痛评分分别为2.3分、1.0分和0.3分。术后12小时内的镇痛使用率也较低（14%）。患者对单个小切口手术非常满意，术后第3天和第14天的平均美观评分分别为9.4分和9.8分。术后过程顺利，随访1个月内无并发症。
LESS肾上腺切除术对于良性肾上腺肿瘤患者是一种安全且技术上可行的手术，具有美容优势和减轻术后疼痛的潜力。然而，缺乏LESS手术经验的外科医生应认识到，针式腹腔镜器械的辅助不会影响困难病例的美容效果，肥胖患者可能并不总是纯LESS技术的合适候选者。
