Laparoscopic Unilateral and Bilateral Adrenalectomy for Cushing's Syndrome

Abstract

Transperitoneal laparoscopic adrenalectomy and RLPA may become the techniques of choice for surgical removal of the adrenal lesions in Cushing's syndrome. The retroperitoneoscopic approach might be a better option in patients with previous abdominal surgery and in patients with pre-existing cardiorespiratory disease.

Laparoscopic Adrenalectomy: Where Do We Stand Now?

“…The choice of each of these techniques is determined particularly by the preference and the experience of the surgeon, but other objective criteria must be taken into consideration, such as the size of the adrenal (combined with the patient's body habitus) and history of previous abdominal surgeries (Fernández-Cruz et al 1996;Suzuki et al 2001) as shown in Table 1.…”

“…Also, the possibility of complications such as visceral and vascular injury may be reduced and postoperative adhesions and peritonitis are minimized (Liapis et al 2008). In addition, the retroperitoneal approach may be beneficial for obese patients or those with pre-existing cardiorespiratory deficiency, because of the avoidance of the hemodynamic and respiratory effects of carbon dioxide pneumoperitoneum (Wolf et al 1995;Fernández-Cruz et al 1996;Fareli-Matin . 1999).…”

“…This includes aldosteronoma, incidentaloma, Cushing's syndrome, adrenal cyst, hormone -secreting tumours, myelolipomas, ganglioneuromas, and other conditions such as adrenal haemorrhage and Conn's syndrome (Fernández-Cruz et al 1996;Gill 2001;Ramacciato et al 2008;Kuruba and Gallagher 2008;Lee et al 2008;Turner and Miskulin 2009). However, bilateral LA is effective for bilateral adrenal hyperplasia, neoplasmas or Cushing's syndrome (Fernández-Cruz et al 1996).…”

“…This includes aldosteronoma, incidentaloma, Cushing's syndrome, adrenal cyst, hormone -secreting tumours, myelolipomas, ganglioneuromas, and other conditions such as adrenal haemorrhage and Conn's syndrome (Fernández-Cruz et al 1996;Gill 2001;Ramacciato et al 2008;Kuruba and Gallagher 2008;Lee et al 2008;Turner and Miskulin 2009). However, bilateral LA is effective for bilateral adrenal hyperplasia, neoplasmas or Cushing's syndrome (Fernández-Cruz et al 1996). The role of LA in patients with large adrenal lesions (> 6 cm), or potential malignancy remains controversial (Sturgeon and kebebew 2004;Cobb et al 2005;Tsuru et al 2005 ;Ramacciato et al 2008;Toniato et al 2007;Eto et al 2008;Marangos et al 2009).…”

“…The advantages of LA versus open adrenalectomy include reduced hospital stay and wound morbidity, decreased transfusion requirements, postoperative pain and complications (Fernández-Cruz et al 1996;Lee et al 2008). Another major breakthrough of the laparoscopic technique is that it can even be performed, in selective cases, as an outpatient procedure by highly skilled surgeons as was first described by Gill et al (2000).…”