Initial Experience with Retroperitoneal Laparoendoscopic Single-Site Surgery for Upper Urinary Tract Surgery

PURPOSE: To report our initial clinical experience and perioperative outcomes of retroperitoneal laparoendoscopic single-site surgery (RLESS) for upper urinary tract surgery. MATERIALS AND METHODS: Between June 2009 and October 2010, we performed RLESS in 23 patients for various indications including radical nephrectomy (n=4), nephroureterectomy (n=2), simple nephrectomy (n=10), and renal cyst ablation (n=7). RLESS was performed with a homemade single-port device with a conventional rigid laparoscopic instrument and laparoscope. The parameters analyzed were age, body mass index, operative time, estimated blood loss, transfusion, time of oral intake, visual analogue pain scale score (VAPS), length of hospital stay, and complications. RESULTS: One case of simple nephrectomy was converted to open nephrectomy because of severe adhesion and inadequate surgical exposure. RLESS was completed in 23 patients. Mean operative time was 168.7+/-29.2, 227.5+/-50.0, 230.0+/-56.5, and 70.5+/-8.9 minutes for simple nephrectomy, radical nephrectomy, nephroureterectomy, and renal cyst ablation, respectively. Estimated blood loss was 113.0+/-149.8, 170.0+/-156.8, 400.0+/-141.4, and 22.8+/-16.0 ml. The time to oral intake after surgery was 1.4+/-0.5, 1.2+/-0.5, 1.5+/-0.7, and 1.1+/-0.3 days. The mean VAPS score was 1.1+/-0.2, 2.1+/-0.5, 2.0+/-0.5, and 1.0+/-0.0 of 10 (range, 0.8 to 2.6). The hospital stay was 4.6+/-1.5, 3.7+/-0.5, 6.0+/-1.4, and 3.2+/-1.7 days. No major perioperative complications were observed. CONCLUSIONS: The initial outcomes of our experience suggest that RLESS is a technically feasible and safe procedure for upper urinary tract surgery. Prospective comparative studies with conventional retroperitoneal laparoscopic surgery are needed to confirm the potential benefits of RLESS.

Unusual Presentation of Bilateral Adrenocortical Carcinoma Mimicking Adrenal Metastasis

A 75-year-old female visited our hospital with bilateral adrenal masses that were detected incidentally during lumbar spine magnetic resonance imaging (MRI) for the evaluation of radiating flank pain. Consecutive computed tomography and MRI revealed bilateral adrenal masses with no evidence of lymph node enlargement or local invasion; 2[(18)F]fluoro-2-deoxyglucose (FDG)-positron emission tomography showed an intense FDG accumulation in both adrenal glands without abnormal FDG uptake in extra-adrenal regions. The laboratory test results were within normal ranges. We performed a bilateral adrenalectomy. The pathologic diagnosis of both adrenal masses was consistent with adrenocortical carcinoma. The patient recovered well with no complications.