Laparoscopic Bilateral Transperitoneal Adrenalectomy for Cushing Syndrome: Surgical Challenges and Lessons Learnt

@article{Aggarwal2013LaparoscopicBT,
  title={Laparoscopic Bilateral Transperitoneal Adrenalectomy for Cushing Syndrome: Surgical Challenges and Lessons Learnt},
  author={Sandeep Aggarwal and Kunal Yadav and Aditya Prakash Sharma and Vrishketan Sethi},
  journal={Surgical Laparoscopy, Endoscopy \& Percutaneous Techniques},
  year={2013},
  volume={23},
  pages={324–328}
}
Purpose: 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. Materials and Methods: From September 2009 to August 2012, we have operated 19 patients with Cushing syndrome and performed bilateral laparoscopic adrenalectomy using the transperitoneal approach; synchronous… 
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References

SHOWING 1-10 OF 18 REFERENCES
Laparoscopic bilateral adrenalectomy: results for 30 consecutive cases
TLDR
Laparoscopic bilateral adrenalectomy is safe and effective for this high-risk patient population, and although patients should be monitored closely in the postoperative period, most are discharged with glucocorticoid and mineraloc Corticoid replacement in a short time without complications.
Bilateral adrenalectomy for Cushing’s syndrome: A comparison between laparoscopy and open surgery
TLDR
Laroscopic bilateral adrenalectomy can be safely and effectively employed to treat Cushing’s syndrome, however, long operatives times may represent a limitation especially in high risk patients.
Laparoscopic adrenalectomy for adrenocorticotropin-dependent Cushing's syndrome.
TLDR
All patients who underwent bilateral laparoscopic adrenalectomy experienced resolution of the signs and symptoms of Cushing's syndrome as well as weight loss, improved glucose tolerance, and improved control of blood pressure.
Synchronous bilateral endoscopic adrenalectomy: experiences after 18 operations
TLDR
The authors advocate early bilateral adrenalectomy for Cushing’s disease after unsuccessful transsphenoidal operation and ectopic adrenocorticotropic hormone production from an inaccessible tumour.
Laparoscopic versus open adrenalectomy in Cushing's syndrome and disease.
TLDR
Cure rate and operative and long-term morbidity were similar for laparoscopic and open adrenalectomies in this series, however, it is important to emphasize that late complications in patients who underwent the posterior open procedure were rather infrequent.
Laparoscopic bilateral adrenalectomy following failed hypophysectomy
TLDR
Clinical experience indicates that laparoscopic bilateral adrenalectomy is a viable treatment option for Cushing’s syndrome following failed hypophysectomy.
Quality of life after laparoscopic bilateral adrenalectomy for Cushing's disease.
TLDR
Results of laparoscopic bilateral adrenalectomy show this procedure is comparable with open Adrenalectomy in controlling symptoms of Cushing's disease.
Total bilateral laparoscopic adrenalectomy in patients with Cushing's syndrome and multiple endocrine neoplasia (IIa)
TLDR
Simultaneous bilateral laparoscopic adrenalectomy is safe, and associated with short hospital stay and lessening of the time needed to achieve normal activity, and not associated with cardiovascular instability.
Endoscopic Retroperitoneal Adrenalectomy: Lessons Learned From 111 Consecutive Cases
TLDR
For benign adrenal tumors less than 6 cm, ERA is recommended and at a median follow-up of 14 months, the recurrence rate of disease was 0.9%.
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