Laparoscopic adrenalectomy for Cushing's syndrome: comparison with primary aldosteronism

Removal of adrenal adenoma of Cushing's syndrome is believed to be more troublesome than primary aldosteronism because of large amount of retroperitoneal adipose tissue and bleeding from the fat. The objective of the present study was to evaluate the feasibility of laparoscopic adrenalectomy for Cushing's syndrome and comparison of the results of laparoscopic adrenalectomy between primary aldosteronism and Cushing's syndrome.

From January 17, 1992, to July 31, 1993, laparoscopic adrenalectomies for functioning adrenal lesions were performed in 14 patients (five men, nine women), three of whom had Cushing's syndrome and 11 of whom had primary aldosteronism.

Operative times (mean +/- SD) for primary aldosteronism and Cushing's syndrome were 269.0 +/- 100.9 minutes and 253.7 +/- 57.9 minutes, respectively. No difference was noted in operative time, operative bleeding, and postoperative recovery between them. However, the weight of removed tissue from patients with Cushing's syndrome (20.00 +/- 8.17 gm) was greater than that from those with primary aldosteronism (6.64 +/- 2.01 gm). No operative complications occurred in patients with Cushing's syndrome. Ultrasonic aspiration and argon-beam coagulation were useful for laparoscopic adrenalectomy in patients with Cushing's syndrome.

Cushing's syndrome may be a good indication for laparoscopic operation.