Total bilateral laparoscopic adrenalectomy in patients with Cushing's syndrome and multiple endocrine neoplasia (IIa)

Abstract

Background: The benefit of simultaneous bilateral laparoscopic adrenalectomy in patients with Cushing's syndrome and pheochromocytoma associated with multiple endocrine neoplasia (MEN) is unknown. Methods: Ten patients underwent laparoscopic adrenalectomy (LpA) with CO₂ pneumoperitoneum for Cushing's syndrome. One MEN patient underwent simultaneous bilateral laparoscopic adrenalectomy with helium pneumoperitoneum for bilateral pheochromocytoma. A comparison was made between unilateral LpA and simultaneous bilateral laparoscopic adrenalectomy in patients with Cushing's syndrome. Plasma catecholamines were correlated with hemodynamic changes in the patient with pheochromocytoma. Results: Simultaneous bilateral laparoscopic adrenalectomy in the patient with pheochromocytoma lasted 330 min. The substantial increase in plasma catecholamines was not associated with cardiovascular instability. Operative time (270 ± 3 vs 120 ± 4 min), blood loss (365 ± 1 vs 210 ± 1 ml), hospital stay (7.6 ± 1.5 vs 4.6 ± 1 days), and normal activity (19.3 ± 2 vs 10.4 ± 4.4 days) were, in patients with Cushing's syndrome, significantly (p < 0.05) higher after simultaneous bilateral laparoscopic adrenalectomy than after unilateral LpA; the differences were not significant in the analgesic requirements (7.6 ± 1 vs 4.6 ± 1 doses). One patient with unilateral LpA was converted to open surgery. Conclusion: Simultaneous bilateral laparoscopic adrenalectomy is safe, and associated with short hospital stay and lessening of the time needed to achieve normal activity.