Bilateral laparoscopic adrenalectomy: retroperitoneal and transperitoneal approaches.

Objectives: To report our experience with bilateral laparoscopic adrenalectomy using either the retroperitoneal or the transperitoneal approach.

Methods: Between June 1998 and October 2000, 6 consecutive patients with bilateral adrenal disease (Cushing syndrome in 4, pheochromocytoma in 1, and solitary adrenal metastases in 1) underwent bilateral laparoscopic adrenalectomy by way of the retroperitoneal or transperitoneal approach. Bilateral adrenalectomy was performed either synchronously (4 patients) or in a staged manner (2 patients).

Results: All laparoscopic procedures were performed successfully. For the bilateral synchronous cases (n = 4) and metachronous cases (n = 4), the median surgical time was 278 and 195 minutes, blood loss was 175 and 125 mL, resumption of oral intake and ambulation required less than 1 day for both groups, and postoperative narcotic requirement comprised 14 and 10 mg morphine sulfate equivalent, respectively. For the synchronous and metachronous cases, the hospital stay was 1.5 and less than 1 day and convalescence was 3 and 2.5 weeks, respectively. An intraoperative surgical complication (adrenal vein bleeding) occurred in 1 case, but did not require open conversion. No postoperative complications or rehospitalization occurred. The retroperitoneal approach was used in 3 of the 4 bilateral synchronous and 3 of the 4 bilateral metachronous cases. In both synchronous and metachronous cases, the actual surgical time, blood loss, time to oral intake and ambulation, postoperative analgesia use, hospital stay, and convalescence of the transperitoneal approach were well within the range of those of the retroperitoneal approach.

Conclusions: Retroperitoneal and transperitoneal bilateral laparoscopic adrenalectomy is feasible, safe, and results in minimal postoperative morbidity.