Feasibility of Bilateral Synchronous Laparoscopic Posterior Retroperitoneal Adrenalectomy for Treatment of Cushing’s Syndrome Due to Bilateral Adrenal Disease

Allison B Weisbrod, MD, Naris Nilubol, MD, Constantine A Stratakis, MD, Electron Kebebew, MD

(1) Endocrine Oncology Branch, National Cancer Institute, National Institutes of Health (2) Walter Reed National Military Medical Center

Introduction: Cushing’s syndrome is often associated with debilitating signs and symptoms and high mortality if untreated. Bilateral adrenal disease is a rare cause of Cushing’s syndrome. Bilateral adrenalectomy is curative for patients with Cushing’s syndrome due to bilateral adrenal disease. This procedure usually requirestwo separate operative preparations and repositioning,thus extendinggeneral anesthesia exposure and operative time. We describe our initial experience with bilateral synchronous laparoscopic adrenalectomy using a posterior retroperitoneal approach.

Methods and Procedures: We compared patient and operative characteristics of 4 bilateral synchronous laparoscopic posterior retroperitoneal adrenalectomies to sequential laparoscopic bilateraladrenalectomies performed by a single surgeon. Outcomes were measured in terms of anesthesia and operative times, estimated blood loss, ICU length of stay, hospital length of stay and post-operative complications.

Results: The mean anesthesiaand operative time improved from 336 ± 100 min and 251 ± 89 min with a sequential procedure to 243 ± 21 min and 169 ± 28 min with a simultaneous procedure. This saved an average of 82 min of operative time and 93 minutes of total anesthesia time. Mean estimated blood loss, mean ICU length of stay and mean hospital length of stay were similar between both groups. No complications and no conversions to open procedure were observed in either group.

Conclusions: The average procedure time for a simultaneous adrenalectomywas shorter compared to a sequential approach. In our early experience, synchronous posterior retroperitoneal bilateral adrenalectomyis a feasible and efficient surgical approach to patients with Cushing’s syndrome due to bilateral adrenal disease.

Session: Poster Presentation

Program Number: P654

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