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

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Abstract

Background

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.

Methods

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.

Results

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.

Conclusion

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.

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Authors and Affiliations

  1. Department of Surgery, Taipei Tzuchi Hospital, The Buddhist Tzu Chi Medical Foundation, Taipei, Taiwan

    Yao-Chou Tsai

  2. Department of Urology, Medical College, Tzu Chi University, Hualien, Taiwan

    Yao-Chou Tsai

  3. Division of Endocrine and Metabolism, Taipei Tzuchi Hospital, The Buddhist Tzu Chi Medical Foundation, Taipei, Taiwan

    Ya-Hui Hu & Leay-Kiaw Er

  4. Division of Nephrology, Taipei Tzuchi Hospital, The Buddhist Tzu Chi Medical Foundation, Taipei, Taiwan

    Che-Hsiung Wu

  5. Glickman Urologic and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA

    Shih-Chieh Chueh

  6. Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH, USA

    Shih-Chieh Chueh

  7. Department of Urology, E-Da Hospital, No. 1 E-da Road, Yan-Chau District, Kaohsiung, Taipei, Taiwan

    Chung-Hsien Chen & Victor Chia-Hsiang Lin

  8. School of Medicine for International Students, I-Shou University, Kaohsiung, Taiwan

    Victor Chia-Hsiang Lin

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Correspondence to Victor Chia-Hsiang Lin.

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Disclosures

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.

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Tsai, YC., Chen, CH., Hu, YH. et al. Factors affecting operative efficiency and post-operative convalescence in laparoendoscopic single-site (LESS) adrenalectomy. Surg Endosc 32, 1449–1455 (2018). https://doi.org/10.1007/s00464-017-5831-3

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  • DOI: https://doi.org/10.1007/s00464-017-5831-3

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