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[Open versus video-endoscopic approach in the treatment of hypercortisolism by bilateral adrenalectomy]
Insights
Bilateral video endoscopic adrenalectomy (BVA) offers improved postoperative outcomes compared to open surgery for hypercortisolism (HC). This minimally invasive approach leads to reduced pain, faster recovery, and fewer complications, making it a valuable alternative.
Area of Science:
- Endocrinology
- Surgical Oncology
- Minimally Invasive Surgery
Background:
- Bilateral adrenalectomy (BA) indications for hypercortisolism (HC) have decreased due to advancements in hypophysectomy and imaging.
- BA remains crucial for refractory HC post-pituitary surgery, ACTH ectopic secretion, and autonomous adrenal secretion.
Purpose of the Study:
- To evaluate the efficacy and safety of bilateral video endoscopic adrenalectomy (BVA) compared to traditional open adrenalectomy for HC treatment.
Main Methods:
- A retrospective study comparing 88 patients undergoing open adrenalectomy (Group 1) over 20 years with 62 patients undergoing BVA (Group 2) since 1994.
- Data analysis focused on preoperative complications, postoperative morbidity, pain, hospital discharge, and parietal complications.
Main Results:
- Two deaths occurred in the open surgery group (Group 1).
- Preoperative complication rates were similar between groups.
- Postoperative morbidity was significantly lower in the BVA group (Group 2), with reduced pain, simpler follow-up, and faster hospital discharge.
Conclusions:
- Bilateral video endoscopic adrenalectomy (BVA) demonstrates superior postoperative outcomes compared to open adrenalectomy.
- BVA offers benefits such as decreased pain, simplified follow-up, and shorter hospital stays.
- Successful BVA requires specialized surgeon training and an adaptation period.
Abstract:
Progress in the technique of the hypophysectomy and in the imaging procedures reduced drastically the indications of bilateral adrenalectomy (BA) in the treatment of hypercortisolism (HC). Indeed BA is indicated in 10 to 30% after failure of pituitary surgery, when HC is related to ACTH ectopic secretion, and in HC related to autonomous adrenal secretion. The purpose of this work is to demonstrate the validity of the bilateral video endoscopic adrenalectomy (BVA) in regard to open surgery. During the last 20 years, 88 patients were operated on by open adrenalectomy (Group 1), either by transperitoneal approach, or bilateral posterior lombetomy. From 1994, 62 patients (Group 2), were operated by video endoscopy. Two death occurred in group 1. The frequency of the preoperative complications were identical in each group, but postoperative morbidity were lower in the group 2. The fall in the postoperative pain, the simplicity of the follow up, the rapid hospital discharge, the low rate of parietal complications were observed in BVA. We conclude that the postoperative follow up is better after BVA a specialized training and time of adaptation are imposed to the surgeon.