Synchronous bilateral adrenalectomy for adrenocorticotropic-dependent Cushing's syndrome

Abstract

Select patients with ACTH-dependent Cushing's syndrome, such as patients with persistent Cushing's disease after failed hypophysectomy or patients with ectopic ACTH production, may require bilateral adrenalectomy. Laparoscopic bilateral adrenalectomy has been described, offering definitive treatment with reduced morbidity compared with open techniques. We report on the performance of synchronous bilateral adrenalectomy treated using the da Vinci robot (Intuitive Surgical, Sunnyvale, CA). To our knowledge, the usage of this minimally invasive approach for this operation has yet to be reported in literature. The details of the case and a brief review of the literature are described herein.

Figure 1.

Computed tomographic scan of abdomen with contrast revealing bilateral adrenal hyperplasia. No masses or nodules seen.

Figure 2.

Diagram of port placement for right sided robotic adrenalectomy. Patient in left lateral decubitis position. Robot docked over ipsilateral shoulder. Ports 1–3 triangulated toward adrenal bed. For left side, patient rotated and ports 1–3 replaced in similar fashion towards left adrenal gland. Assistant ports 4 and 5 used for right and left adrenalectomy. AAL=anterior axillary line; MCL=midclavicular line; ML=midline.