Simultaneous bilateral transperitoneal laparoscopic adrenalectomy (SBTLA)
Ferenc Juhasz, Zsolt Kanyari, Ferenc Gyory & Géza Lukacs
Background and Purpose: Laparoscopic adrenalectomy has become the preferred surgical approach to manage adrenal disorders. Bilateral adrenalectomy is performed for diseases that are unresponsive to medical management and, frequently, for neoplastic disease. The aim of this study was to review our experience with laparoscopic bilateral adrenalectomy and to evaluate its safety, efficacy, and outcomes.
Patients and Methods: Between May 1999 and May 2005, four male and four female patients with a mean age of 37 years (range 2455 years) presented for bilateral adrenalectomy (pheochromocytoma [N=4], Cushings disease [N=2], malignant neuroendocrine tumor [N=1] and incidentaloma [N=1]. All procedures were performed using a simultan bilateral transperitoneal approach (SBTLA).
Results: Laparoscopic bilateral transperitoneal adrenalectomy was completed simultaneously in eight patients, while in one case the operation was converted due to the neuroendocrine carcinoma localised just behind the confluence of the right renal vein and I.V.C. One tripple tumor was operated by the staged procedure because there was no agreement on a one stage (simultan) operation between the chest surgeon consultant and us. The mean operative time was 189 minutes (range 165240 minutes), and the mean estimated blood loss was 76 mL (range 5590 mL). There were no postoperative complications. All patients have been treated postoperatively with daily hydrocortisone and fludrocortisone replacement. After a mean follow-up of 33 months (range 245 months), all of the eight patients are alive.
Conclusion: Simultan bilateral transperitoneal laparoscopic adrenalectomy is a safe and effective procedure. Patients are discharged postoperatively in a relatively short time with few complications. Appropriate steroid replacement (if its necessary) and close follow-up allows these patients to return to their regular life style. The meticulous adrenal preserving technic of the LA makes possible to avoid unnecessary hormone supplementation.