Aggarwal Sandeep, Yadav Kunal, Sharma Aditya P, Sethi Vrishketan
Department of Surgical Disciplines, All India Institute of Medical Sciences (AIIMS), Ansari Nagar, New Delhi, India.
Surg Laparosc Endosc Percutan Tech. 2013 Jun;23(3):324-8. doi: 10.1097/SLE.0b013e318290126d.
Laparoscopic adrenalectomy is well established for treatment of adrenal lesions. However, bilateral adrenalectomy for Cushing syndrome is a challenging and time-consuming operation. We report our experience of laparoscopic bilateral adrenalectomy for this disease in 19 patients.
From September 2009 to August 2012, we have operated 19 patients with Cushing syndrome and performed bilateral laparoscopic adrenalectomy using the transperitoneal approach; synchronous in 15 patients and staged in 4 patients. In 15 patients, the surgery was carried out sequentially on both the sides in lateral position with intraoperative change in position. Complete adrenalectomy including periadrenal fat was carried out on both the sides.
Nineteen patients were referred from Department of Endocrinology for bilateral adrenalectomy for adrenocorticotropin hormone (ACTH)-dependent and ACTH-independent Cushing syndrome. The indications for surgery were Cushing disease in 15 patients, occult/ectopic source of ACTH in 2 patients, and primary adrenal hyperplasia in 2 patients. Fifteen patients underwent bilateral adrenalectomy during the same operation. Four patients underwent staged procedures. All procedures were completed laparoscopically with no conversions. The mean operating time for simultaneous bilateral adrenalectomy was 210 minutes (range, 150 to 240 min). This included the repositioning and reprepping time. There were no major intraoperative complications. The average blood loss was 100 mL (range, 50 to 200 mL). None of the patients required blood transfusions in the postoperative period. The postoperative complications included minor port-site infection in 2 patients. One severely debilitated patient died on the 14th postoperative day because of hospital-acquired pneumonia. The remaining 18 patients have done well in terms of impact on the disease.
Laparoscopic bilateral adrenalectomy for Cushing syndrome is feasible and safe. It confers all the advantages of minimally invasive approach such as less postoperative pain, shorter hospitalization, lesser wound complications, and faster recovery. The advantages of the laparoscopic approach have led to an earlier referral for bilateral adrenalectomy by endocrinologist in patients with failed pituitary surgery.
腹腔镜肾上腺切除术已广泛用于肾上腺病变的治疗。然而，双侧肾上腺切除术治疗库欣综合征是一项具有挑战性且耗时的手术。我们报告了19例因该病接受腹腔镜双侧肾上腺切除术的经验。
2009年9月至2012年8月，我们为19例库欣综合征患者实施手术，采用经腹途径行双侧腹腔镜肾上腺切除术；其中15例同期手术，4例分期手术。15例患者在侧卧位下依次进行双侧手术，术中改变体位。双侧均行包括肾上腺周围脂肪的完整肾上腺切除术。
19例患者由内分泌科转诊来行双侧肾上腺切除术，病因包括促肾上腺皮质激素（ACTH）依赖性和ACTH非依赖性库欣综合征。手术适应证为库欣病15例、隐匿/异位ACTH来源2例、原发性肾上腺增生2例。15例患者同期行双侧肾上腺切除术。4例患者分期手术。所有手术均在腹腔镜下完成，无中转开腹。同期双侧肾上腺切除术的平均手术时间为210分钟（范围150至240分钟）。这包括重新定位和重新铺巾时间。术中无重大并发症。平均失血量为100毫升（范围50至200毫升）。术后无一例患者需要输血。术后并发症包括2例轻微的切口感染。1例极度虚弱的患者术后第14天因医院获得性肺炎死亡。其余18例患者在疾病影响方面情况良好。
腹腔镜双侧肾上腺切除术治疗库欣综合征可行且安全。它具有微创方法的所有优点，如术后疼痛减轻、住院时间缩短、伤口并发症减少和恢复更快。腹腔镜手术方法的优点促使内分泌科医生在垂体手术失败的患者中更早地转诊进行双侧肾上腺切除术。
