title: Surgical outcomes of laparoscopic adrenalectomy for patients with Cushing's and subclinical Cushing's syndrome: a single center experience.
abstract: OBJECTIVE
  We retrospectively examined the outcome of patients who underwent laparoscopic adrenalectomy for Cushing's/subclinical Cushing's syndrome in our single institute.
  
  
  METHODS
  Between 1994 and 2008, a total of 114 patients (29 males and 85 females, median age 54 years) with adrenal Cushing's/subclinical Cushing's syndrome were studied. We compared the outcome of patients who underwent laparoscopic adrenalectomy between intraperitoneal and retroperitoneal approaches. Surgical complications were graded according to the Clavien grading system. We also examined the long-term results of subclinical Cushing's syndrome after laparoscopic adrenalectomy.
  
  
  RESULTS
  Laparoscopic surgical outcome did not differ significantly between patients with Cushing's syndrome and those with subclinical Cushing's syndrome. Patients who underwent laparoscopic intraperitoneal adrenalectomy had longer operative time than those who received retroperitoneal adrenalectomy (188.2 min vs. 160.9 min). However, operative blood loss and surgical complications were similar between both approaches. There were no complications of Clavien grade III or higher in either intraperitoneal or retroperitoneal approach. We confirmed the improvement of hypertension and glucose tolerance in patients with subclinical Cushing's syndrome after laparoscopic adrenalectomy.
  
  
  CONCLUSIONS
  Laparoscopic adrenalectomy for adrenal Cushing's/subclinical Cushing's syndrome is safe and feasible in either intraperitoneal or retroperitoneal approach. The use of the Clavien grading system for reporting complications in the laparoscopic adrenalectomy is encouraged for a valuable quality assessment.
authors.affiliation: Department of Urology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8574 Japan. Mminoru@uro.med.tohoku.ac.jp
authors.forename: Minoru
authors.initials: M
authors.lastname: Miyazato
authors.forename: Shigeto
authors.initials: S
authors.lastname: Ishidoya
authors.forename: Fumitoshi
authors.initials: F
authors.lastname: Satoh
authors.forename: Ryo
authors.initials: R
authors.lastname: Morimoto
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Kaiho
authors.forename: Shigeyuki
authors.initials: S
authors.lastname: Yamada
authors.forename: Akihiro
authors.initials: A
authors.lastname: Ito
authors.forename: Haruo
authors.initials: H
authors.lastname: Nakagawa
authors.forename: Sadayoshi
authors.initials: S
authors.lastname: Ito
authors.forename: Yoichi
authors.initials: Y
authors.lastname: Arai
mesh_terms: D000315:Adrenalectomy / Q000009:adverse effects / Q000379:methods*; D000328:Adult; D000368:Aged; D058070:Asymptomatic Diseases / Q000628:therapy; D016063:Blood Loss, Surgical; D003480:Cushing Syndrome / Q000150:complications / Q000601:surgery*; D003920:Diabetes Mellitus / Q000188:drug therapy / Q000209:etiology; D005260:Female; D006801:Humans; D006973:Hypertension / Q000188:drug therapy / Q000209:etiology; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology*; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult