Laparo-endoscopic Single Site Surgery (less) for Intra-Abdominal Solid Organs: A Case Control Study.

Iris J Parrao-alcantara, UNDERGRADUATED MEDICAL DOCTOR, Xeily Zarate, MD, Juan Pablo Pantoja, MD, Mauricio Sierra, MD, David Velazquez-fernandez, MD PHD, Miguel F Herrera, MD PHD. Instituto Nacional de la Nutrición Salvador Zubirán


BACKGROUND: One of the most promising uses of LESS are surgical procedures requiring organ retrieval such as splenectomy, adrenalectomy and pancreatic resections. The aim of the present study was to analyze our initial results with LESS in these 3 surgical procedures, using a case control design.
PATIENTS AND METHODS: All patients who underwent LESS at our institution between 2010 and 2011 were reviewed. Exclusively three surgical techniques were considered for the study: splenectomy, adrenalectomy, and pancreatic resection. These were considered the case group, while controls were patients who underwent conventional laparoscopy for the same diagnosis. Case and controls were matched according to their preoperative diagnosis. Main outcome variables were: surgical time, conversion rate, cure of the disease, and operative complications. Preliminary statistical analysis was performed according to the variable scaling using SPSS v. 13.0. Statistical significance was considered with a p value was lesser than 0.05.
RESULTS: Nineteen cases were included (10 splenectomies, 4 adrenalectomies, and 5 pancreatic resections). All splenectomies were performed for Idiopathic thrombocitopenic purpura. Adrenalectomies were indicated for the treatment of benign hyperfunctioning or non -functional adrenocortical tumors. Insulinoma was the surgical indication for all pancreatic resections. Surgical approach for splenectomy and adrenalectomy was lateral subcostal, and anterior for all pancreatic resections. There were no conversions. A group of 16 matched controls (11 splenectomies and 5 adrenalectomies) met inclusion criteria. Patients with pancreatic resections were all females. Three distal pancreatectomies and 2 enucleations were performed. Mean operative time was 240.4±62.67 min. Two patients developed a pancreatic fistula (1 “A” and 1 “B”). Comparative results for splenectomies and adrenalectomies are shown below. Although the statistical power is limited, there were no statistical differences among cases and controls.

SPLENECTOMY LESS (10) Laparoscopic (11)
Female, n (%) 8 (80%) 8 (72.7%)
Surgical time, min 155.9 ± 47.22 125.9 ± 47.94
Complete/Parcial/No response, n 8 / 2 / 0 9 / 1 / 1
Complications, n 1 Incisional hernia 0
ADRENALECTOMY LESS (4) Laparoscopic (5)
Female, n (%) 4 (100%) 5 (100%)
Surgical time, min 166.6 ± 41.63 144.4 ± 65.32
Cushing/Conn/Non-functioning, n 1 / 1 / 2 0 / 0 / 5
Complications, n 0 0

CONCLUSIONS: LESS in splenectomy, adrenalectomy, and pancreatic resection for insulinoma offers the well-known cosmetic advantages of the technique without deleterious effects on clinical outcomes when compared with conventional laparoscopy. Moreover, LESS did not involve a longer surgical time in this series. Therefore we believe that LESS is an optimal alternative to conventional laparoscopic surgery, with improved cosmetic results and similar outcomes.

Session Number: SS07 – Solid Organ
Program Number: S046

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