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


CONCLUSIONS
Simultaneous bilateral laparoscopic adrenalectomy is safe, and associated with short hospital stay and lessening of the time needed to achieve normal activity.
Fernández-Cruz
L
L
Department of Surgery, Hospital Cliníc, University of Barcelona, C/ Villarroel, 170, 08036-Barcelona, Spain.
Sáenz
A
A
Benarroch
G
G
Sabater
L
L
Taurá
P
P
D000315:Adrenalectomy / Q000379:methods; D000328:Adult; D000368:Aged; D002395:Catecholamines / Q000032:analysis; D003480:Cushing Syndrome / Q000150:complications / Q000601:surgery*; D005069:Evaluation Studies as Topic; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000503:physiopathology*; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D018813:Multiple Endocrine Neoplasia Type 2a / Q000150:complications / Q000601:surgery*; D010673:Pheochromocytoma / Q000150:complications / Q000601:surgery*; D011028:Pneumoperitoneum, Artificial / Q000379:methods; D016896:Treatment Outcome
D002395:Catecholamines