V4-08: Laparoendoscopic Single-Site (LESS) Adrenalectomy in Morbidly Obese Patient with Cushing Syndrome
VideoIntroductions and Objectives
LESS has been described as an alternative minimally invasive treatment option for different urologic pathologies. However, LESS is still has limitations with strict patients selection criteria. We present LESS adrenalectomy for a morbidly obese patient with Cushing syndrome and relatively large left adrenal mass.
We present 32 years old female patient who was diagnosed clinically, biochemically and radiologically as Cushing syndrome. Computed tomography (CT) of the abdomen and pelvis showed 6.6 X 5.8 X 4.5 cm left adrenal tumor. BMI of the patient was 42. While the patient in the modified flank position, LESS left adrenalectomy was done using Covedien port that as placed at the umbilicus through 2.5- cm skin incision. During LESS adrenalectomy we used both articulating and straight instruments as well as 5-mm EndoEye camera. Dissection started by medial reflection of the left descending colon. The left adrenal vein was identified and clipped and en-bloc dissection of the adrenal gland and the tumor was done using both blunt and sharp dissection. Finally the gland was retrieved in an Endo-bag through the port site.
The operative time was 180 minutes. Blood loss was 200 c.c and there was no blood transfusion. There was no conversion to open surgery or conventional laparoscopy. No extra-port was added. There were no intraoperative or postoperative complications. The postoperative umbilical incision after retrieval of the tumor was 3.5 cm. Hospital stay was 3 days. Visual Analogue Pain Scale at discharge was 2. The patient required only non-steroidal anti-inflammatory as postoperative analgesics. Histopathology confirmed the diagnosis of adrenal cortical adenoma.
LESS adrenalecomy is feasible and safe option for morbidly obese patients with Cushing syndrome. Although technically difficult, the procedure has low morbidity and high patient satisfaction.