LAPAROSCOPIC BILATERAL ADRENALECTOMY FOR PERSISTENT CUSHINGS-DISEASE AFTER TRANSSPHENOIDAL SURGERY

Background. We performed bilateral laparoscopic adrenalectomies on fou r patients (three women and one man! with Cushing's disease (pituitary -dependent Cushing's syndrome) showing persistent hypercortisolism aft er transsphenoidal surgery. Methods. The technique for bilateral trans peritoneal laparoscopic adrenalectomy was derived from the one previou sly adopted by our group for unilateral adrenalectomy and previously d escribed. Eight trocars were used, of which two were used for both lef t and right adrenalectomy. Results. Bilateral laparoscopic adrenalecto my was performed in a one-stage procedure in tile three women and, bec ause of the abundant abdominal fat of the Patient, in a two-stage proc edure (after a 1-week interval) in the man. Operating times for the th ree women were 255 minutes, 230 minutes, and 220 minutes, and for the man 170 minutes for rig ht adrenalectomy and 140 minutes for left adre nalectomy. No surgical or anesthesiologic complications were encounter ed. All patients were discharged om the hospital within 5 days after o peration. At Present, after follow-up periods of 23, 8, 6, and 18 mont hs, all patients show remission of Cushing's disease and undetectable cortisol levels. Conclusions. Our experience suggests that bilateral l aparoscopic adrenalectomy is a safe and effective procedure and a vali d therapeutic option in Patients with Cushing's disease showing persis tent hypercortisolism after transsphenoidal surgery. However; the deci sion to remove both adrenal glands in such patients needs to be weighe d against the risk of their having Nelson's syndrome or other long-ter m complications.