Laparoscopic adrenalectomy for patients who have Cushing's syndrome

Laparoscopic adrenalectomy is safe, effective, and curative, and it shortens hospitalization and convalescence. Laparoscopic adrenalectomy is the procedure of choice for the surgical management of Cushing's syndrome patients who have cortisol-producing adenomas (unilateral or bilateral), ACTH-dependent Cushing's syndrome and failed surgery for the removal of the source of ACTH, bilateral primary pigmented nodular adrenal disease, and ACTH-independent bilateral adrenal macronodular hyperplasia. Contraindications for laparoscopic adrenalectomy include adrenocortical carcinomas, very large tumors (eg, greater than 10 cm in diameter), and patients who have malignant ACTH-secreting pheochromocytomas. The keys to successful laparoscopic adrenalectomy are appropriate patient selection, knowledge of anatomy, delicate tissue handling, meticulous hemostasis, and experience with advanced laparoscopic surgery.