Longitudinal analysis of laparoendoscopic single-site adrenalectomy and conventional laparoscopic adrenalectomy regarding patient-reported satisfaction and cosmesis outcomes

Laparoscopic Single-Incision Triangulated Umbilical Surgery Adrenalectomy for Large (>5 cm) Tumors of the Adrenal Gland: Initial Experience with 16 Cases

Background and ObjectivesLaparoscopic single-incision triangulated umbilical surgery (SITUS), which enables the extraction of intraabdominal specimens through a single umbilical incision, has yet to be used to perform adrenalectomy. We have modified SITUS to enable extraction of large (>5 cm) adrenal masses with optimal cosmetic outcomes and investigated efficacy and safety. Methods. In this retrospective study, we analyzed data of 16 patients with adrenal tumors >5 cm who had undergone adrenalectomy by SITUS between October 2015 and April 2018. Two C-shaped incisions were made around the umbilicus and sutured centripetally. After extracting the specimen, we evaluated these patients' operative/postoperative data. Results. SITUS was performed in all 16 patients without conversion to laparoscopic or open surgery. The mean operation time was 75.31 ± 21.54 min (intraperitoneal time 41.94 ± 17.57 min; incision suturing time 33.38 ± 6.34 min). The estimated median blood loss was 57.5 mL (range 30–610 mL). Drainage time and duration of hospital stay were 55.69 ± 12.92 h and 3.94 ± 0.90 d, respectively. After surgery, all incisions were hidden under the umbilicus. Three patients developed keloid diathesis, resulting in enlargement of their scars. Conclusions. SITUS is a safe and feasible procedure for removing large adrenal tumors. In addition to its cosmetic advantages, SITUS facilitates functional recovery, particularly in patients with large adrenal tumors.

Longitudinal analysis of retroperitoneoscopic adrenalectomy regarding cosmesis outcomes: comparison of lateral transperitoneal and reduced port laparoscopic adrenalectomy

The aim of this study is to compare patient-reported cosmesis and satisfaction outcomes between lateral retroperitoneoscopic adrenalectomy (LRA), laparoendoscopic single site and reduced port adrenalectomy (LESS/RP-A) and lateral transperitoneal laparoscopic adrenalectomy (LTA). A total of 26, 86 and 50 patients who underwent LRA, LESS/RP-A and LTA were included in the study. All LESS/RP-A cases were performed taking the transumbilical approach. We mailed a questionnaire to all patients 1, 3, 6, 9 and 12 months after operation. Questionnaires inquiring about cosmesis (0: very ugly, 10: very beautiful) on the basis of a visual analogue scale were administered. The mean scores of cosmesis at postoperative months 1, 3, 6, 9 and 12 were 7.11, 7.00, 6.57, 5.25 and 5.46 for the LRA group, 8.43, 8.86, 8.95, 8.46 and 9.09 for the LESS/RP-A group and 7.18, 7.74, 7.58, 7.44 and 8.09 for the LTA group. The difference in cosmesis score between the LRA and LESS/RP-A groups gradually increased after surgery, and the cosmesis score for the LRA group was significantly lower at every postoperative point. The difference in cosmesis score between the LRA and LTA groups gradually increased after surgery, and the cosmesis score for the LRA group was significantly lower at postoperative months 9 (p = 0.015) and 12 (p = 0.002). This study is the first comprehensive longitudinal analysis of patient-reported cosmesis outcomes between LRA, LESS/RP-A and LTA. LRA was the surgical procedure that resulted in lower cosmesis scores when compared with those following the LESS/RP-A and LTA procedures.

Laparoendoscopic single-site adrenalectomy versus multi-port laparoendoscopic adrenalectomy: A systemic review and meta-analysis

Background

To investigate the outcomes of laparoendoscopic single-site adrenalectomy (LESS-A) compared to multi-port laparoendoscopic adrenalectomy (m-LA).

Methods

Studies comparing LESS-A with m-LA were identified from PubMed, Embase, and Cochrane Library before June 2020. Post-operative pain, resumption outcomes, and perioperative outcomes were analyzed. We conducted meta-analyses using the Mantel-Haenszel method with random-effects model. Subset analyses were conducted according to peritoneal and retroperitoneal approaches. A small study effect was illustrated using funnel plots and Egger's test.

Results

One randomized controlled trial (RCT) and nineteen retrospective cohort studies involving 1554 patients were included for analyzed. Pooled analysis showed that LESS-A had significantly lower postoperative pain scores (MD −0.77, 95%CI −1.45 to −0.10) and less pain medication used (RR 0.74, 95%CI 0.60 to 0.91) compared to m-LA. Besides, LESS-A had significantly shorter hospital stays (MD −0.75, 95%CI −1.18 to −0.33), shorter duration of oral intake resumption (MD −0.33, 95%CI −0.60 to −0.06), and better cosmetic satisfaction (SMD 1.15, 95%CI 0.21 to −2.09). As for perioperative outcomes, LESS-A led to significant longer operative time (MD 13.43, 95%CI 4.08 to 22.77). No significant differences were observed in terms of the remaining perioperative outcomes.

Conclusions

LESS-A is associated with less post-operative pain and quicker recovery duration. However, the longer operative time of LESS-A compared with m-LA is a drawback.

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Multi-port laparoscopic adrenalectomy (m-LA) is widely used for treatment of benign adrenal tumor.

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Laparoscopic single-site adrenalectomy (LESS-A) had significant less post-operative pain and less pain medication consumption comparing with m-LA.

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LESS-A had better resumption outcomes, including shorter hospital stay and quicker post-operative oral intake.

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LESS-A offer better cosmetic satisfaction.

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Longer operative time is a drawback of LESS-A.

Comparison of Chief Surgeons' and Assistants' Feelings of Fatigue Between Laparoendoscopic Single-site and Conventional Laparoscopic Adrenalectomy

BACKGROUND

Our objective was to compare the surgical staff's feelings of fatigue between laparoendoscopic single-site adrenalectomy (LESS-A) and conventional laparoscopic adrenalectomy (CLA) before and after surgery.

METHOD

Data were collected for surgical procedures performed between June 2011 and September 2017 (57 LESS-A and 37 CLA). Each procedure in both groups was performed by the same chief surgeon. The subjective fatigue feelings of the key members of the surgical team (chief surgeon, scopist, assistant surgeon) were assessed using the "Jikaku-sho shirabe" questionnaire, which contained questions about work-related feelings of fatigue. It consisted of 25 subjective items for 5 factors drawn from factor analysis (drowsiness, instability, uneasiness, local pain or dullness, and eyestrain). For each item, the participants were requested to estimate the intensity of their feelings using a five-point rating scale before and after surgery.

RESULTS

There was no significant difference in operative time (p = 0.231) between the LESS-A and CLA procedure groups. For the chief surgeon, local pain or dullness (p = 0.603) and eyestrain (p = 0.086) were similar between the LESS-A and CLA procedures. The scopists and assistant surgeons in the LESS-A group did not suffer local pain or dullness (p = 0.793 and p = 0.240, respectively). They did, however, suffer more eyestrain than those in the CLA group (p = 0.001 and p = 0.001, respectively).

CONCLUSION

Although LESS-A is generally considered to be a technically difficult procedure, the results of this study demonstrate that the feelings of physical fatigue are roughly equivalent between LESS-A and CLA procedures.

Factors associated with patient satisfaction in laparoscopic adrenalectomy

Laparoscopic adrenalectomy a treatment that is recommended for patients with adrenal adenoma and has been shown to lead to a 94% biochemical remission rate of aldosterone as well as improvements to quality of life in five domains of the SF-36. This method is also associated with high rates of patient satisfaction. However, there is little information available on the factors associated with patient satisfaction in cases of laparoscopic adrenalectomy. This study aimed to evaluate these factors in patients with Conn's syndrome who underwent laparoscopic adrenalectomy. This study was based on a survey and was conducted at Srinagarind Hospital at the Khon Kaen University Faculty of Medicine in Thailand. The inclusion criteria were that patients were between 15 and 60 years of age, had been diagnosed with adrenal gland tumors, and had undergone trnasperitoneal laparoscopic adrenalectomy. All eligible patients were asked to fill out a self-report questionnaire in which they rated their satisfaction (out of 10) and factors associated with their level of satisfaction in the areas of clinical treatment and scarring. There were 44 patients who participated in the study. The average (SD) age of all patients was 47.10 (10.90) years. The average overall satisfaction scores for the surgery and with regard to scarring post surgery were 9.47 (1.15) and 8.11 (2.21), respectively. Only the presence of headaches was an independent factor associated with the overall satisfaction, with a coefficient of -0.29 (p value 0.001). Only age was significantly predictive of overall satisfaction with regard to scarring with a coefficient of 0.05 and p value of 0.046. In conclusion, the presence of headaches was related to overall satisfaction and age was associated with satisfaction with regard to scarring in patients Conn's syndrome who underwent laparoscopic adrenalectomy.