challenging approach that limits the broader application of the technique. The surgeon is confronted with a number of additional difficulties compared to using conventional laparoscopy, such as the lack of instrument triangulation, instrument shaft clashing, and the need for ambidexterity. Needlescopic-assisted LESS surgery could avoid the major difficulties encountered during the single-site approach. We aimed to compare perioperative parameters between needle-assisted and conventional LESS adrenalectomy (LESS-A). METHODS: 18 consecutive patients undergoing needle- assisted LESS-A were compared with 29 patients undergoing con- ventional LESS-A at Hiroshima University Hospital between November 2009 and September 2013. Needle-assisted LESS-A was performed using MiniLap instruments (Stryker, San Jose, CA, USA). We used this instrument protectively retracted the liver in the right side and the spleen in the left side of the tumour by grasping the endo- scopic surgical spacer SECUREA TM (Hogy Medical Co., Ltd., Tokyo, Japan). RESULTS: LESS-A was completed successfully with no major intraoperative complications in all cases. The two treatment cohorts had similar age, body mass index (BMI), gender, and laterality. Needle- assisted LESS-A was significantly performed in the transumbilical approach rather than in the subcostal approach. The insufflation time of the needle-assisted LESS-A was shorter than that of the conventional LESS-A (p ¼ 0.0635). No patients required intraoperative or post- operative blood transfusions. CONCLUSIONS: The introduction of the MiniLap instrument spares one access port in the main abdominal multichannel port that can be used to house other necessary instruments. Needle-assisted LESS-A was performed safely, and this avoided many of the difficulties of LESS surgery. Table 1 Patient characteristics and parameters classified by operative approach. Needle-assisted Conventional p-value Case 18 29 Age (yrs) 53.8 55.5 0.6340 BMI (kg/m 2 ) 22.3 23.7 0.1808 Tumour size (mm) 22.2 22.0 0.9731 Sex (Male:Female) 7:11 15:14 0.3913 Approach (Subcostal: Transumbilical) 7:11 26:3 0.0002 Laterality (Left:Right) 12:6 13:16 0.1447 Insufflation time (min) 122.1 155.9 0.0635 Estimated blood loss (mL) 28.5 32.8 0.6475 Source of Funding: none PD1-09 LAPAROSCOPIC PARTIAL VERSUS TOTAL ADRENALECTOMY FOR ADRENAL MASSES Oh Seok Ko*, Hyung Jin Kim, Young Beom Jeong, Jeonju, Korea, Republic of INTRODUCTION AND OBJECTIVES: The indication for lapa- roscopic total or partial adrenalectomy in patients with adrenal mass remains still controversial. We compared laparoscopic total adrenalec- tomy (LTA) and partial adrenalectomy (LPA) in terms of surgical as well as functional outcomes. METHODS: Between May 2004 and July 2013, 77 trans- peritoneal laparoscopic adrenalectomies were performed for adrenal gland masses (15 Conn’s adenomas, 18 pheochromocytomas, 7 Cushing’s adenomas, 19 nonfunctioning tumors, 4 adrenal cysts, 5 metastatic tumors from other site, 3 primary adrenal carcinoma, and 3 neural tumors). All surgery was performed by single surgeon. LTA was performed in 49 patients and LPA in 28. In 28 patients 31 tumors were removed by LPA. We compared perioperative and long-term outcomes of two surgical methods. RESULTS: 49 patients underwent LTA, 28 including 3 pa- tients with bilateral mass did LPA. There were no differences be- tween the two groups (LTA versus LPA) with regard to patients 0 mean age at presentation (49.47Æ12.73 vs 50.44Æ9.20, p¼0.609), mean tumor size (3.15Æ1.78 cm vs 3.25Æ1.65 cm, p¼0.607), postoperative stay (5.64Æ2.25 days vs. 5.35Æ2.03 days, p¼0.641), analgesic requirement and time to diet. However, mean operating time was significantly shorter in LPA than that of LTA (198.85Æ59.33 min vs.144.42Æ55.02 min, p<0.001). Mean esti- mated blood loss in LPA group was significantly higher than in the LTA group (43.53Æ55.65 ml vs. 67.03Æ35.82 ml, p¼0.028) but no patient needed blood transfusion. One conversion to open surgery was in LTA and no major complications developed. Mean followup was 25.11Æ26.48 months in LTA, 28.11Æ19.46 months in LPA, respectively. Hypokalemia was corrected postoperatively in all pa- tients with Conn’s adenoma, but 1 patient for each group was still hypertensive and prescribed decreased dose of antihypertensive medications at final followup. All patients with functional adrenal masses such as pheochromocytoma, Conn’s adenoma and Cush- ing’s adenoma had biochemically normalized data after surgery. There were no local recurrences at operation site in patients with neural tumors as well as metastatic tumors during followup. CONCLUSIONS: Our data demonstrate that LPA is a safe, technically feasible and useful procedure in patients with adrenal mass whether it is biochemically active or not. Source of Funding: None PD1-10 ROLE OF POSITRON EMISSION TOMOGRAPHY/COMPUTED TOMOGRAPHY (PET/CT) IN THE EVALUATION OF THE METASTATIC ADRENAL MASSES Onur KAYGISIZ, Gokhun Ozmerdiven, Yakup Kordan, Burhan Coskun, Hakan Vuruskan, Ismet Yavascaoglu*, Bursa, Turkey INTRODUCTION AND OBJECTIVES: To investigate the role of PET/CT imaging in the diagnosis of the patients with suspected non small cell lung cancer (NSCLC) metastases in the adrenal gland. METHODS: Forty-one patients with suspected metastases Laparoscopic Adrenalectomy was performed in our clinic between March 2004 and July 2013. Fourteen patients without PET imaging were excluded from the study. The primary tumors in 22 were NSCLC. The parameters of the patients and peak standardized uptake values (SUVmax) were compared between the groups with benign and ma- lignant pathologies. RESULTS: Metastases were found in 17 adrenal masses (74%). Sex of the patient, sub-type of the lung cancer and the size of the adrenal mass were ineffective for the prediction of the metastasis (table). Together with this, the SUVmax value was found as signifi- cantly higher in the metastatic group (table). If the threshold value of SUV max for metastatic were taken as 3, sensitivity would be 100% and specificity would be 50%; whereas if the same value were taken as 4 or 5, sensitivity would be 88.2% and 76.5, respectively, and specificity would be 82.4% and 100%, respectively. CT or MRI were ineffective in determining the metastases (p¼0,179). Specificity was 83.3%, while sensitivity was only 60%. However, in case we accepted the presence of suspicious metastasis based on CT or MRI as the criterion in the group we took the SUV max threshold value as 4, one patient more would be diagnosed to increase sensitivity to 94.11% and to decrease specificity to 66%. Likewise, taking the threshold SUV max value as 5 would allow diagnosing of 2 more patients and diagnosis of only 1 patient would be missed increasing sensitivity to 94.1% and lowering specificity to 83.3%. CONCLUSIONS: In our series, PET/CT appears as an effective imaging modality to determine the adrenal metastases in patients with Vol. 191, No. 4S, Supplement, Friday, May 16, 2014 THE JOURNAL OF UROLOGY â e13