Surgical Endoscopy

, Volume 32, Issue 3, pp 1449–1455 | Cite as

Factors affecting operative efficiency and post-operative convalescence in laparoendoscopic single-site (LESS) adrenalectomy

  • Yao-Chou Tsai
  • Chung-Hsien Chen
  • Ya-Hui Hu
  • Leay-Kiaw Er
  • Che-Hsiung Wu
  • Shih-Chieh Chueh
  • Victor Chia-Hsiang Lin



Laparoendoscopic single-site (LESS) adrenalectomy is a novel challenging technique which is still under clinical evaluation. Initial reports have revealed its superiority in patient convalescence. In addition, it has been reported that some patient or anatomic factors might affect the ergonomics of LESS adrenalectomy. The aim of this study is to investigate the possible factors that might affect procedural efficiency and patient convalescence in LESS adrenalectomy.


Between October 2009 and July 2015, 105 consecutive adult patients with benign adrenal tumors, who underwent LESS retroperitoneal adrenalectomy were enrolled in this study. All the relevant peri-operative parameters were prospectively collected for later analysis. By using stepwise linear regression and stepwise selection of these peri-operative parameters, those that might affect the operative efficiency and patient convalescence were analyzed.


Finally, 78 patients who completed follow-up and were eligible for stepwise linear regression were enrolled for final analysis. For parameters affecting operative efficiency, the fitted model revealed that patients with a pre-operative diagnosis of pheochromocytoma, a higher BMI, and an associated co-morbidity of heart disease are associated with a longer operative time. In addition, the fitted model revealed that patients with a lower post-operative pain score, a delayed oral intake, and a diagnosis of non-functioning adrenal tumor were associated with a lengthier period before returning to normal activity.


A higher BMI is the only anatomic factor that affects procedural efficiency in LESS adrenalectomy. In addition, post-operative pain score, time to oral intake, and a diagnosis of non-functioning adrenal tumor are the factors affecting patient convalescence.


LESS Adrenalectomy Convalescence Ergonomics 


Compliance with ethical standards


Yao-Chou Tsai, Chung-Hsien Chen, Ya-Hui Hu, Leay-Kiaw Er, Che-Hsiung Wu, Shih-Chieh Chueh, and Victor Chia-Hsiang Lin have no conflicts of interest or financial ties to disclose.


  1. 1.
    Gagner M, Lacroix A, Bolte E (1992) Laparoscopic adrenalectomy in Cushing’s syndrome and pheochromocytoma. N Engl J Med 327(14):1033CrossRefPubMedGoogle Scholar
  2. 2.
    Hompson GB, Grant CS, van Heerden JA et al (1997) Laparoscopic versus open posterior adrenalectomy: a case-control study of 100 patients. Surgery 122(6):1132–1136CrossRefGoogle Scholar
  3. 3.
    Autorino R, Cadeddu JA, Desai MM et al (2011) Laparoendoscopic single-site and natural orifice transluminal endoscopic surgery in urology: a critical analysis of the literature. Eur Urol 59:26–45CrossRefPubMedGoogle Scholar
  4. 4.
    Eret V, Schmidt M, Stránský P et al (2012) Laparoendoscopic single- site surgery (LESS) in urology—a new frontier in minimally invasive surgery? Ces Urol 16:146–156Google Scholar
  5. 5.
    Liatsikos E, Kallidonis P, Kyriazis I, Al-Aown A, Stolzenburg JU (2009) Urologic laparoendoscopic single-site surgery. Nat Rev Urol 6:654–659CrossRefPubMedGoogle Scholar
  6. 6.
    Lin VC, Tsai YC, Chung SD et al (2012) A comparative study of multiport versus laparoendoscopic single-site adrenalectomy for benign adrenal tumors. Surg Endosc 26:1135–1139CrossRefPubMedGoogle Scholar
  7. 7.
    Desai MM, Berger AK, Brandina R et al (2009) Laparoendoscopic single-site surgery: initial hundred patients. Urology 74:805–812CrossRefPubMedGoogle Scholar
  8. 8.
    Stolzenburg JU, Kallidonis P, Till H, Burchardt M, Herrmann TR, Liatsikos EN (2009) Current status of laparoendoscopic single-site surgery in urology. World J Urol 27:767–773CrossRefPubMedGoogle Scholar
  9. 9.
    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 31:199–203CrossRefPubMedGoogle Scholar
  10. 10.
    Walz MK, Groeben H, Alesina PF (2010) Single-access retroperitoneoscopic adrenalectomy (SARA) versus conventional retroperitoneoscopic adrenalectomy (CORA): a case-control study. World J Surg 34:1386–1390CrossRefPubMedGoogle Scholar
  11. 11.
    Chung SD, Huang CY, Wang SM, Tai HC, Tsai YC, Chueh SC (2011) Laparoendoscopic single-site (LESS) retroperitoneal adrenalectomy using a homemade single-access platform and standard laparoscopic instruments. Surg Endosc 25:1251–1256CrossRefPubMedGoogle Scholar
  12. 12.
    Ho CS, Liao PW, Lin Victor C, Jaw FS, Chueh Jeff SC et al (2015) Laparoendoscopic single-site (LESS) retroperitoneal partial adrenalectomy using a custom-made single-access platform and standard laparoscopic instruments: Technical considerations and surgical outcomes. Asian J Surg 38:6–12CrossRefPubMedGoogle Scholar
  13. 13.
    Wu CH, Er LK, Hu YH, Lin CD, Chueh SC, Tsai YC (2016) Is laparoendoscopic single-site adrenalectomy a feasible alternative in treating aldosterone-producing adenoma? Biomed Res Int 6894381Google Scholar
  14. 14.
    Giebler RM, Behrends M, Steffens T, Walz MK, Peitgen K, Peters J (2000) Intraperitoneal and retroperitoneal carbon dioxide insufflation evoke different effects on caval vein pressure gradients in humans: evidence for the starling resistor concept of abdominal venous return. Anesthesiology 92:1568–1580CrossRefPubMedGoogle Scholar
  15. 15.
    Giebler RM, Walz MK, Peitgen K, Scherer RU (1996) Hemodynamic changes after retroperitoneal CO2 insufflation for posterior retroperitoneoscopic adrenalectomy. Anesth Analg 82:827–831PubMedGoogle Scholar
  16. 16.
    Walz MK, Alesina PF, Wenger FA et al (2006) Posterior retroperitoneoscopic adrenalectomydresults of 560 procedures in 520 patients. Surgery. 140:943–948 discussion 948–950 CrossRefPubMedGoogle Scholar
  17. 17.
    Cindolo L, Gidaro S, Tamburro FR, Schips L (2010) Laparoendoscopic single-site left transperitoneal adrenalectomy. Eur Urol 57:911–914CrossRefPubMedGoogle Scholar
  18. 18.
    Wang L, Wu Z, Li M et al (2013) Laparoendoscopic single-site adrenalectomy versus conventional laparoscopic surgery: a systematic review and meta-analysis of observational studies. J Endourol 27:743–750CrossRefPubMedGoogle Scholar
  19. 19.
    Hu Q, Gou Y, Sun C et al (2013) A systematic review and meta-analysis of current evidence comparing laparoendoscopic single-site adrenalectomy and conventional laparoscopic adrenalectomy. J Endourol 27:676–683CrossRefPubMedGoogle Scholar
  20. 20.
    Clements T, Raman JD (2011) Laparoendoscopic single-site pyeloplasty. Ther Adv Urol 3:141e9CrossRefGoogle Scholar
  21. 21.
    Khanna R, Stein RJ, White MA, Isac W, Laydner H, Autorino R et al (2012) Single institution experience with robotic laparoendoscopic single site renal procedures. J Endourol 26:230–234CrossRefPubMedGoogle Scholar
  22. 22.
    Hirasawa Y, Miyajima A, Hattori S, Miyashita K, Kurihara I, Shibata H, Oya M (2014) 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(10):2911–2919CrossRefPubMedGoogle Scholar
  23. 23.
    Chu N-F (2005) Prevalence of obesity in Taiwan. Obes Rev 6(4):271–274CrossRefPubMedGoogle Scholar
  24. 24.
    Zeng Q, He Y, Dong S, Zhao X, Chen Z, Song Z, Wang Y (2014) Optimal cut-off values of BMI, waist circumference and waist: height ratio for defining obesity in Chinese adults. Br J Nutr 112(10):1735–1744CrossRefPubMedGoogle Scholar
  25. 25.
    Hwang LC, Bai CH, Chen CJ (2006) Prevalence of obesity and metabolic syndrome in Taiwan. J Formos Med Assoc 105(8):626–635CrossRefPubMedGoogle Scholar
  26. 26.
    Liu L, Miura K, Fujiyoshi A, Kadota A, Miyagawa N, Nakamura Y, Ueshima H (2014) Impact of metabolic syndrome on the risk of cardiovascular disease mortality in the United States and in Japan. Am J Cardiol 113(1):84–89CrossRefPubMedGoogle Scholar
  27. 27.
    Toniato A, Boschin IM, Opocher G, Guolo A, Pelizzo M, Mantero F (2007) Is the laparoscopic adrenalectomy for pheochromocytoma the best treatment? Surgery 141:723–727CrossRefPubMedGoogle Scholar
  28. 28.
    Dickson PV, Alex GC, Grubbs EG, Ayala-Ramirez M, Jimenez C, Evans DB, Lee JE, Perrier ND (2011) Posterior retroperitoneoscopic adrenalectomy is a safe and effective alternative to transabdominal laparoscopic adrenalectomy for pheochromocytoma. Surgery 150:452–458CrossRefPubMedGoogle Scholar
  29. 29.
    Tuna MM, Imga NN, Doğan BA, Yılmaz FM, Topçuoğlu C, Akbaba G, Güler S (2014) Non-functioning adrenal incidentalomas are associated with higher hypertension prevalence and higher risk of atherosclerosis. J Endocrinol Invest 37(8):765–768CrossRefPubMedGoogle Scholar
  30. 30.
    Oki K, Yamane K, Nakanishi S, Shiwa T, Kohno N (2012) Influence of adrenal subclinical hypercortisolism on hypertension in patients with adrenal incidentaloma. Exp Clin Endocrinol Diabetes 120(04):244–247CrossRefPubMedGoogle Scholar
  31. 31.
    Chung F, Ritchie E, Su J (1997) Postoperative pain in ambulatory surgery. Anesth Analg 85(4):808–816CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  • Yao-Chou Tsai
    • 1
    • 2
  • Chung-Hsien Chen
    • 7
  • Ya-Hui Hu
    • 3
  • Leay-Kiaw Er
    • 3
  • Che-Hsiung Wu
    • 4
  • Shih-Chieh Chueh
    • 5
    • 6
  • Victor Chia-Hsiang Lin
    • 7
    • 8
  1. 1.Department of Surgery, Taipei Tzuchi HospitalThe Buddhist Tzu Chi Medical FoundationTaipeiTaiwan
  2. 2.Department of Urology, Medical CollegeTzu Chi UniversityHualienTaiwan
  3. 3.Division of Endocrine and Metabolism, Taipei Tzuchi HospitalThe Buddhist Tzu Chi Medical FoundationTaipeiTaiwan
  4. 4.Division of Nephrology, Taipei Tzuchi HospitalThe Buddhist Tzu Chi Medical FoundationTaipeiTaiwan
  5. 5.Glickman Urologic and Kidney InstituteCleveland ClinicClevelandUSA
  6. 6.Cleveland Clinic Lerner College of MedicineCase Western Reserve UniversityClevelandUSA
  7. 7.Department of UrologyE-Da HospitalKaohsiungTaiwan
  8. 8.School of Medicine for International StudentsI-Shou UniversityKaohsiungTaiwan

Personalised recommendations