Bilateral laparoscopic adrenalectomy

Laparoscopic adrenalectomy has become the gold standard in the surgical management of adrenal pathology. Bilateral adrenalectomy is indicated in patients with Cushing's disease secondary to macroadenoma or hypophysial hyperplasia in whom medical treatment and transsphenoid surgery have failed. Also, it is the first choice for bilateral benign tumors and metastatic neoplasia. We present our experience with bilateral laparoscopic adrenalectomy, analyzing its indications, feasibility, results, and complications.

Between November 1999 and December 2005, 221 laparoscopic adrenalectomies were performed by the same surgeon (OAC) at our institution. Of the 221 adrenalectomies, 44 were bilateral. A total of 20 patients underwent bilateral synchronic laparoscopic adrenalectomy (91%); the remaining 2 had two-stage procedures. There were 6 cases of bilateral pheochromocytoma, 6 patients with Cushing's disease, 3 cases of metastasis, 3 congenital adrenal hyperplasias, 2 hyperaldosteronisms, and a single case each of adrenal adenoma and myelolipoma. The average patient age was 41.6 years (range 17-72 years), and the male-to-female ratio was 1:2.6.

Total laparoscopic adrenalectomy and partial adrenalectomy were performed on 37 and 7 occasions (84% and 16%), respectively. The mean tumor size was 4.15 cm (range 1-11 cm). The mean operative time for each adrenalectomy was 79.2 minutes (range 25-210 minutes). The estimated intraoperative blood loss was on average 65.4 mL (range 0-500 mL). Only one patient required a blood transfusion. There was only one intraoperative complication (2.2%), a renal-vein injury that was controlled with intracorporeal suturing. There were no open conversions. The mean hospital stay was 3.19 days (range 2-5 days).

Bilateral laparoscopic adrenalectomy is technically feasible and can be performed with minimal bleeding in a reasonable surgical time.