Bilateral Simultaneous Laparoscopic Adrenalectomy in Cushing's Syndrome: Safe, Effective, and Curative

Tiyadatah, Balagopal Nair; Kalavampara, Sanjeevan Vasudevan; Sukumar, Sudhir; Mathew, Georgie; Pooleri, Ginil Kumar; Prasanna, Ajish Thankappan; Gopalakrishnan, Unnikrishnan; Hattangadi, Sanjay Bhat

doi:10.1089/end.2011.0295

Cited by 13 publications

(16 citation statements)

References 26 publications

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“…1,26,47 Extra time is required to reposition and prepare the patient for removal of the second gland. 1,49 Nonetheless, the increased operative time does not appear to have a negative impact on the patient's recovery. In fact, Mikhal et al found that despite the longer operative times for the laparoscopic group, the estimated blood loss and postoperative hematocrit drop were lower than those in the open group, which may be attributable to the decreased overall transfusion rate and benefits of pneumoperitoneum.…”

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confidence: 99%

“…46,49 Proper administration of exogenous glucocorticoids is required to maintain hormonal functioning and balance. 20 Because in CD the pituitary gland is the origin of disease, routine observation of growth and secretory function of the pituitary gland using MRI and ACTH measurements remains essential.…”

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confidence: 99%

“…A disadvantage of this approach is that it requires insertion of additional ports and has been reported to increase operative time. 49 A more direct access to the adrenal glands is provided by the retroperitoneal approach. In addition, no repositioning of the patient is required for a bilateral adrenalectomy, which may reduce operative time, and any abdominal adhesions from previous abdominal surgeries can be avoided.…”

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confidence: 99%

“…Consequently, exploration of the abdominal cavity is unavailable for concomitant pathology. 49 Because working space is more limited in this approach, dissection and exposure are more difficult and therefore may not be appropriate for larger lesions. This approach may also be more difficult, especially in patients with CD as they have more retroperitoneal fat.…”

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confidence: 99%

“…The magnification during laparoscopic adrenalectomy also allows for better visibility of the surgical field, leading to a decreased risk of leaving behind adrenal remnants. 20,49,52 With CS, most adrenal lesions are small and pathologically benign, and so are well suited for laparoscopic excision. 20 In addition, patients with CS typically present with increased adipose tissue, and for this reason the laparoscopic approach may be more appealing than an open laparotomy.…”

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The role of bilateral adrenalectomy in the treatment of refractory Cushing's disease

Wong¹,

Eloy

Liu

2015

FOC

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Cushing's syndrome (CS) results from sustained exposure to excessive levels of free glucocorticoids. One of the main causes of CS is excessive adrenocorticotropic hormone (ACTH) secretion by tumors in the pituitary gland (Cushing's disease [CD]). Cushing's disease and its associated hypercortisolism have a breadth of debilitating symptoms associated with an increased mortality rate, warranting urgent treatment. Currently, the first line of treatment for CD is transsphenoidal surgery (TSS), with excellent long-term results. Transsphenoidal resections performed by experienced surgeons have shown remission rates ranging from 70% to 90%. However, some patients do not achieve normalization of their hypercortisolemic state after TSS and continue to have persistent or recurrent CD. For these patients, various therapeutic options after failed TSS include repeat TSS, radiotherapy, medical therapy, and bilateral adrenalectomy (BLA). Bilateral adrenalectomy has been shown to be a safe and effective treatment modality for persistent or recurrent CD with an immediate and definitive cure of the hypercortisolemic state. BLA was traditionally performed through an open approach, but since the advent of laparoscopic adrenalectomy, the laparoscopic approach has become the surgical method of choice. Advances in technology, refinement in surgical skills, competency in adrenopathology, and emphasis on multidisciplinary collaborations have greatly reduced morbidity and mortality associated with adrenalectomy surgery in a high-risk patient population. In this article, the authors review the role of BLA in the treatment of refractory CD. The clinical indications, current surgical and endocrinological results reported in the literature, surgical technique (open vs laparoscopic), drawbacks, and complications of BLA are discussed.

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