LAPAROSCOPIC VERSUS OPEN POSTERIOR ADRENALECTOMY - COMPARISON OF ACUTE-PHASE RESPONSE AND WOUND-HEALING IN THE CUSHINGOID PORCINE MODEL

This prospective randomized study examined the acute-phase response an d wound healing, comparing laparoscopic (LA) and open qosterior (PA) a drenalectomy in a cushingoid porcine model. Repository corticotropin g el was given to 40 pigs for 21 days. Biochemical and tissue parameters of Cushing syndrome were confirmed. The pigs were randomized to under go LA or PA. In addition to operating time and morbidity, the acute-ph ase response was compared by measuring the postoperative white blood c ell count, fasting glucose, C-reactive protein, and nitrogen balance. Wound healing was assessed by (1) scored (1-4) gross appearance at 48 hours and 1 and 2 weeks; (2) histologic examination; and (3) tensile s trength, There was no difference in operating time (mean +/- SD) (36 /- 9 minutes open vs. 37 +/- 7 minutes laparoscopic), perioperative mo rtality, degree of leukocytosis, fasting glucose, or C-reactive protei n (p > 0.05). Nitrogen balance, wound scores, and tensile strength at 24 hours arid 1 week were more favorable in the LA group than in the P A group (p < 0.05). In the cushingoid porcine model, laparoscopic adre nalectomy was less catabolic and was associated with fewer wound compl ications than the open posterior adrenalectomy. These findings provide support for continued pursuit of laparoscopic methods for adrenalecto my in the clinical setting.