ACTH-dependent Cushing syndrome: The potential benefits of simultaneous bilateral posterior retroperitoneoscopic adrenalectomy

Bilateral adrenalectomy can provide definitive cure of hypercortisolism in persistent or recurrent Cushing's disease after unsuccessful pituitary surgery, irradiation or both, in nonresectable, corticotrophin-secreting neoplasms and in primary adrenal bilateral disease.1 Laparoscopic adrenalectomy has become the standard option for benign adrenal lesions, especially in patients with Cushing's syndrome. [2], [3] and [4] For bilateral adrenalectomy, the standard laparoscopic flank approach is associated with longer operative time compared with conventional surgery, because of the need to reposition the patient after removing the first gland.3 An alternative technique is represented by the posterior, retroperitoneoscopic approach (PRA),5 which eliminates the need to reposition the patient. We evaluated a simultaneous bilateral PRA, with 2 different surgical teams operating at the same time, 1 per side. Five patients with ACTH-dependent Cushing syndrome were selected for simultaneous bilateral PRA between January 2007 and May 2009. All patients were positioned prone. Two different surgical teams of a surgeon, assistant, and nurse and equipment (monitor, insufflator, camera, and surgical instrumentation) were assembled on each side of the patient. Simultaneous bilateral PRA was accomplished successfully in all 5 patients. The median operative time was 120 minutes (range, 70–160). The postoperative course was uneventful. We think that our preliminary experience demonstrates that simultaneous bilateral PRA is feasible and safe. Despite the fact that it requires 2 different well-trained surgical teams, it offers the possibility to decrease the operative time for bilateral adrenalectomy by up to 50% and to reduce operative stress.