Retroperitoneal laparoscopic adrenalectomy is feasible for primary aldosteronism. However, Cushing's syndrome is presently a much more difficult indication than primary aldosteronism for this new operative technique.

We report the case of a 58-year-old woman with renal cell carcinoma in whom real-time transesophageal sonographic monitoring of the tumor thrombus in the inferior vena cava provided dynamic information, allowing us to determine the appropriate operative procedure to use. Observation of the thrombus throughout the operation showed that mobilization of the liver resulted in compression of the inferior vena cava against the spine, increasing the risk of migration of the tumor thrombus and reinforcing the need to maintain adequate positioning of the liver to prevent such compression. The surgery was completed successfully, and the patient's postoperative course was uneventful. We recommend the use of real-time transesophageal sonographic monitoring of the tumor thrombus during such surgical procedures.

No abstract

We report the case of a spontaneously ruptured adrenal adenoma which caused Cushing’s syndrome. The 34-year-old female patient had severe leftside back pain and anemia. Computerized tomography disclosed a retroperitoneal hemorrhage and a 4-cm mass on the left which was considered to be an adrenal tumor. An operation was successfully performed, and the patient is well 12 months after surgery.

Retroperitoneal laparoscopic adrenalectomy is feasible for primary aldosteronism. However, Cushing's syndrome is presently a much more difficult indication than primary aldosteronism for this new operative technique.