Synchronous bilateral endoscopic adrenalectomy: experiences after 18 operations.
BACKGROUND
Patients who undergo unilateral adrenalectomy are known to benefit from the endoscopic procedure. Only a few reports on bilateral endoscopic adrenalectomy exist. The optimal approach and the value of this operation were assessed in this study.


METHODS
For 18 patients, synchronous bilateral lateral adrenalectomy with intraoperative repositioning was performed for different indications. The transperitoneal and retroperitoneal approaches were varied on both sides.


RESULTS
With the reported procedure, the operative time diminished considerably. Blood loss was low, and no blood transfusions were required. No conversion to an open procedure was necessary. There were no intraoperative or postoperative complications, except for one death from pulmonary embolism. The mean postoperative hospital stay was 7 days, and the follow-up evaluation showed overall improvement.


CONCLUSIONS
The risk associated with endoscopic bilateral adrenalectomy is low. Transperitoneal and retroperitoneal lateral adrenalectomy are recommended as approaches of choice. The authors advocate early bilateral adrenalectomy for Cushing's disease after unsuccessful transsphenoidal operation and ectopic adrenocorticotropic hormone production from an inaccessible tumour.
Jäger
F
F
Department of General and Abdominal Surgery, University Hospital of Mainz, 55101 Mainz, Germany.
Jäger
E
E
Heintz
A
A
Junginger
T
T
D000182:ACTH Syndrome, Ectopic / Q000150:complications; D000236:Adenoma / Q000150:complications / Q000473:pathology / Q000601:surgery; D000310:Adrenal Gland Neoplasms / Q000150:complications / Q000473:pathology / Q000601:surgery; D000315:Adrenalectomy / Q000379:methods*; D000328:Adult; D003480:Cushing Syndrome / Q000209:etiology / Q000473:pathology / Q000601:surgery; D004724:Endoscopy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018813:Multiple Endocrine Neoplasia Type 2a / Q000601:surgery; D010673:Pheochromocytoma / Q000473:pathology / Q000601:surgery; D010911:Pituitary Neoplasms / Q000150:complications; D011183:Postoperative Complications; D011655:Pulmonary Embolism / Q000209:etiology; D016896:Treatment Outcome