V11-06: Posterior Retroperitoneoscopic Bilateral Adrenalectomy in Ectopic Cushing`s Syndrome
Over the years, a number of different surgical approaches to the adrenal glands have been described. Minimally invasive adrenalectomy has become the procedure of choice for benign adrenal pathology. Although the adrenal glands are located in the retroperitoneum, most surgeons prefer the transperitoneal laparoscopic approach. The purpose of this video is to show the feasibility of performing a posterior retroperitoneoscopic bilateral adrenalectomy in a woman with ectopic Cushing`s syndrome.
A 23-year-old woman presented with past medical history of metastatic Pancreatic Neuroendocrine Tumor with ectopic production of Gastrin and ACTH treated with Lanreotide since 2004. The patient was referred to the department of urology with Cushing`s disease, refractory to medical treatment. The CT scan showed an enlarged liver due to multiple metastases, that collapsed the right adrenal space. For this reasons, we decided a posterior retroperitoneoscopic bilateral adrenalectomy.
The patient was placed in prone position. Three trocars were placed 2 centimeters under the 12th rib, between sacroespinalis muscle and posterior axillary line. A small cavity in the retroperitoneum was made with blunt finger dissection. Once the right adrenal space was created, we could identify the anatomic landmarks (psoas, diaphragm, liver). Dissection of the gland was begun with lower margin detachment from the upper kidney pole in a lateral to medial direction using 5?mm ultrasonic dissector. After exposing adrenal gland from surrounding tissue and medial isolation of the main adrenal vein, the vessel was clipped and divided with scissors. We repeated the same steps for the left side. The operation time was 103 minutes, with no postoperative complications. The patient had a fast recovery and was discharged on the third postoperative day. Cushing`s syndrome symptoms resolved completely.
The posterior retroperitoneoscopic bilateral adrenalectomy appears to be a safe and effective technique, with short operative time and fast recovery, but thorough knowledge of retroperitoneal anatomy is required.