Homemade Single-port Laparoscopic Retroperitoneal Adrenalectomy.

Correspondence To the Editor: Laparoendoscopic single‑site surgery (LESS) has been widely used for various urologic diseases in order to improve safety, outcomes, and cosmesis, and to further reduce invasiveness. [1] Here, we reported our initial experience with laparoendoscopic single‑site retroperitoneal partial adrenalectomy using a homemade single‑port device in a municipal hospital. Totally, 18 patients (seven men and 11 women, aged 31–76 years, average age: 56 years) with adrenal tumors were enrolled in this study from June 2011 to June 2014. Laboratory tests including urine cortisol, serum cortisol, sodium, potassium, renin, angiotensin, aldosterone, and catecholamine were performed to assess the nature of pathological changes. The patients' height, weight, and body mass index were measured. All patients were diagnosed and localized before operation using multiple devices including ultrasound, computed tomography, magnetic resonance imaging. Ten lesions localized in the left side, and eight lesions localized in the right side. The adrenal tumor diameter ranged from 1.1 to 3.5 cm with an average of 2.1 cm. All patients underwent laparoscopic retroperitoneal adrenalectomy using homemade single‑port LESS. A homemade single‑port device was introduced to laparoscopic retroperitoneal adrenalectomy. The device was made from #18 Foley's urine tube by bending the front side of the tube to a ring with about 6 cm in diameter and cutting off the rest of catheter. The ring was wrapped by sterile latex gloves packages rings up to the thumb roots of 5 cm and was fixed with sterile adhesive tape. Since the ring can fix the single‑port device on the abdominal muscle and fascia, all finger channels can be used for surgical instruments operations (Olympus A50002A Electronic Laparoscopic, Olympus UHI‑3 aerator, Olympus OTV‑S7/ Olympus CLV‑S40 Image acquisition system and traditional hard laparoscopic instruments from Olympus Inc. Through a muscle‑splitting incision (about 2.5–3.0 cm) in the midaxillary line, the retroperitoneal space was entered. During insertion of the homemade single‑port device, the ring was fixed lower than the muscle layer. Two sets of 10‑mm puncture trocar and one 5‑mm puncture trocar were placed and were fixed by ligature to ensure the tightness after the tip of the finger of sterile gloves cut open. Carbon dioxide insufflated to maintain an intra‑abdominal pressure of 15 mmHg. Then, through the other 10 mm and the 5 mm trocar, LigaSure or ultrasonic knife and dissecting instruments were introduced. The adrenal adenomas can be found within the triangle among the upper pole of the kidney, peritoneal and …