TOTAL BILATERAL LAPAROSCOPIC ADRENALECTOMY IN PATIENTS WITH CUSHINGS-SYNDROME AND MULTIPLE ENDOCRINE NEOPLASIA (IIA)

Background: The benefit of simultaneous bilateral laparoscopic adrenal ectomy in patients with Gushing's syndrome and pheochromocytoma associ ated with multiple endocrine neoplasia (MEN) is unknown. Methods: Ten patients underwent laparoscopic adrenalectomy (LpA) with CO2 pneumoper itoneum for Gushing's syndrome, One MEN patient underwent simultaneous bilateral laparoscopic adrenalectomy with helium pneumoperitoneum for bilateral pheochromocytoma. A comparison was made between unilateral LpA and simultaneous bilateral laparoscopic adrenalectomy in patients with Gushing's syndrome. Plasma catecholamines were correlated with he modynamic changes in the patient with pheochromocytoma. Results: Simul taneous bilateral laparoscopic adrenalectomy in the patient with pheoc hromocytoma lasted 330 min, The substantial increase in plasma catecho lamines was not associated with cardiovascular instability. Operative time (270 +/- 3 vs 120 +/- 4 min), blood loss (365 +/- 1 vs 210 +/- 1 mi), hospital stay (7.6 +/- 1.5 vs 4.6 +/- 1 days), and normal activit y (19.3 +/- 2 vs 10.4 +/- 4.4 days) were, in patients with Gushing's s yndrome, significantly (p < 0.05) higher after simultaneous bilateral laparoscopic adrenalectomy than after unilateral LpA; the differences were not significant in the analgesic requirements (7.6 +/- 1 vs 4.6 /- 1 doses). One patient with unilateral LpA was converted to open sur gery. Conclusion: Simultaneous bilateral laparoscopic adrenalectomy is safe, and associated with short hospital stay and lessening of the ti me needed to achieve normal activity.