Laparoscopic simultaneous bilateral partial and total adrenalectomy: a longer follow-up.

Objective: To examine the feasibility and safety of laparoscopic simultaneous bilateral adrenal surgery (LSBAS) and to compare the results between laparoscopic total adrenalectomy (TA) and partial adrenalectomy (PA).

Patients And Methods: Between 1999 and January 2008, 12 patients underwent LBAS in our institution, with TA used in four with Cushing's disease refractory to pituitary surgery or radiation, in one with occult ectopic adrenocorticotropic hormone (ACTH) Cushing's syndrome, and one with bilateral adrenal macronodular hyperplasia. Six patients (five with primary aldosteronism and one with Cushing's syndrome) had bilateral functioning tumours had bilateral PAs.

Results: All 12 operations were completed with no intraoperative complication, conversion, re-operation or death. The mean (range) operative duration was 323 (180-560) min, and the mean estimated blood loss was 79 (20-200) mL. There was adrenal insufficiency after surgery in three patients. Patients who had a PA had significantly longer surgery than those treated with TA, with a mean (sd) of 390 (36) vs 255 (27) min.

Conclusion: LSBAS is technically feasible; although surgery was longer than TA, bilateral PA in patients with bilateral functioning tumours mitigated the need for life-long steroid replacement.