Mini-laparoscopic adrenalectomy with transgastric specimen extraction
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ORIGINAL ARTICLE
Mini‑laparoscopic adrenalectomy with transgastric specimen extraction Fatih Sumer1 · Yusuf Murat Bag1 · Mehmet Can Aydin1 · Bahri Evren2 · Emine Sener Aydin2 · Ibrahim Sahin2 · Cuneyt Kayaalp1 Received: 23 July 2020 / Accepted: 16 October 2020 © Italian Society of Surgery (SIC) 2020
Abstract We aimed to describe the initial experience of mini-laparoscopic adrenalectomy combined with transgastric specimen extraction and to assess its safety and feasibility. We used only 5-mm trocars, three ports for left adrenalectomy and four for right. Intraoperative gastroscopy was performed for specimen extraction through the mouth via an endoscopic snare. The gastrotomy was closed intracorporeally. Demographic, perioperative and pathological data were analyzed. There were 16 patients (12 females) with the mean age of 46.5 ± 11.3 years and half of them had previous abdominal surgeries. The median operative time was 150 (45–432) min with a median blood loss of 88 (0–350) ml. The median oral intake time was 2 (1–4) days and the median length of hospital stay was 2 (2–5) days. There was no mortality and extraction-related complication. Histopathological median tumor length, width and depth were 3 cm, 2.15 cm, and 1.9 cm, respectively. The median specimen length, width and depth were 6.25 cm, 4 cm, and 2.2 cm, respectively. Mini-laparoscopic adrenalectomy combined with transgastric specimen extraction is a safe and feasible surgical technique. It provides a less invasive surgery and may also have some benefits on wound-related complications and cosmesis. Keywords NOTES · NOSE · Transoral · Minimally invasive surgery · Natural orifice surgery
Introduction Minimally invasive adrenalectomy has become the preferred surgical treatment for many adrenal lesions due to less postoperative pain, shorter hospital stay, and faster recovery [1, 2]. However, enlarging the trocar site or an additional abdominal wall incision is necessary to remove the specimen. This reduces the advantages of laparoscopy by increasing trocar site complications, postoperative pain and worsening cosmetic results. After a widespread acceptance of laparoscopic approaches in adrenal surgery, a trend to quest and perform less and less invasive methods, such as laparo-endoscopic single-site surgery (LESS) and natural orifice transluminal endoscopic surgery (NOTES), came up [3]. Natural orifice * Yusuf Murat Bag [email protected] 1
Department of Gastrointestinal Surgery, Inonu University, Malatya, Turkey
Department of Endocrinology and Metabolism, Inonu University, Malatya, Turkey
2
specimen extraction (NOSE) that allows the specimens to be removed via natural orifices (i.e., vagina, mouth,anus) without any additional incision or enlarging trocar incisions, has become a reality particularly for colorectal resections. The combination of mini-laparoscopic adrenalectomy and NOSE may have the same benefits by reducing the abdominal wall trauma. We aimed to describe the initial experience of mini-laparoscopic adrenalectomy combined with
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