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 mi), 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. Conclusion: Simultaneous bilateral laparoscopic adrenalectomy is safe, and associated with short hospital stay and lessening of the time needed to achieve normal activity.