Longitudinal Incision of the Umbilicus for Laparoendoscopic Single Site Adrenalectomy: A Particular Intraumbilical Technique


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Abstract

BackgroundWe describe our initial clinical experience of laparoendoscopic single site (LESS) adrenalectomy.MethodsWe describe a 49-year-old woman who was diagnosed with subclinical Cushing syndrome because of a left adrenal tumor and underwent LESS adrenalectomy. We everted the umbilical depression and made the longitudinal skin incision of the umbilicus at the mid-line. Then, the wider area of the subcutaneous tissue was dissected to accommodate the placement of the 3 trocars through the longitudinal umbilical skin incision. The procedure was performed in a standard manner with the use of the roticular instruments to overcome the lack of triangulation that occurs with a single access.ResultsThere were no intraoperative or postoperative complications. The patient reported pain scores of 0 to 1 in the validated Visual Analog Pain Scale and postoperatively she required no narcotics. The scar receded into the umbilicus and was hardly visible.ConclusionsHerein we presented the “particular intraumbilical approach” for LESS adrenalectomy. Longitudinal incision of the umbilicus and the wider area of subcutaneous tissue dissection accommodate the multiple ports and seemed to solve the problem associated with crossover instrumentation. The incision length was within the depression of the umbilicus; therefore, this simple technique also preserves the normal umbilical appearance.

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