<p>Sir,</p> <p>After I read the Letter to Editor <sup> <xref ref-type="bibr" rid="ref1">1</xref> </sup>(Synchronous bilateral adrenalectomy by midline incision: A reliable method for treatment of hypercortisolism) and Letter to Editor <sup> <xref ref-type="bibr" rid="ref2">2</xref> </sup>Re: Tabatabaee et al. in JRMS, I found some studies which may be useful in this regard..</p> <p>Bilateral adrenalectomy either by open (BOA) or laparoscopic (BLA) approach remains a safe and definitive management for corticotrophin (ACTH)-dependent Cushing′s syndrome.</p> <p>Open adrenalectomy remains a consideration when concomitant intra-abdominal procedures are necessary in select patients with ectopic ACTH syndrome, or when laparoscopic techniques are either inappropriate or unavailable. <sup> <xref ref-type="bibr" rid="ref3">3</xref> </sup></p> <p>To date, there is a few published information that directly compares open and laparoscopic approach of bilateral adrenalectomy.</p> <p>Laparoscopic procedure for adrenalectomy has become widely accepted since its initial description in 1992. <sup> <xref ref-type="bibr" rid="ref1">1</xref> </sup>, <sup> <xref ref-type="bibr" rid="ref2">2</xref> </sup></p> <p>Although Propilia et al. (2004) <sup> <xref ref-type="bibr" rid="ref4">4</xref> </sup>and Acosta et al. (1999) <sup> <xref ref-type="bibr" rid="ref5">5</xref> </sup>found no difference in complications and in the length of hospital stay between BOA and BLA procedures, respectively, more numerous recent reports have demonstrated that laparoscopic adrenalectomy is associated with a shorter hospital stay, faster recovery, improved patient satisfaction, lower morbidity rate, favorable outcomes, and fewer perioperative complications (especially, wound related) than open adrenalectomy. <sup> <xref ref-type="bibr" rid="ref6">6</xref> </sup>, <sup> <xref ref-type="bibr" rid="ref7">7</xref> </sup>, <sup> <xref ref-type="bibr" rid="ref8">8</xref> </sup>, <sup> <xref ref-type="bibr" rid="ref9">9</xref> </sup>, <sup> <xref ref-type="bibr" rid="ref10">10</xref> </sup>, <sup> <xref ref-type="bibr" rid="ref11">11</xref> </sup>, <sup> <xref ref-type="bibr" rid="ref12">12</xref> </sup>, <sup> <xref ref-type="bibr" rid="ref13">13</xref> </sup>, <sup> <xref ref-type="bibr" rid="ref14">14</xref> </sup>, <sup> <xref ref-type="bibr" rid="ref15">15</xref> </sup>, <sup> <xref ref-type="bibr" rid="ref16">16</xref> </sup>, <sup> <xref ref-type="bibr" rid="ref17">17</xref> </sup></p> <p>Additionally, postoperative analgesic requirements have been shown to be significantly less, following BLA when compared with BOA. <sup> <xref ref-type="bibr" rid="ref3">3</xref> </sup></p> <p>The overall rates for mortality and complications from the 12 series are 2.4% and 13%, respectively. <sup> <xref ref-type="bibr" rid="ref18">18</xref> </sup>, <sup> <xref ref-type="bibr" rid="ref19">19</xref> </sup></p> <p>Hence, in experienced centers, BLA is safe and effective; more often avoiding problems associated with open approaches these being especially problematic in the patients with hypercortisolism. <sup> <xref ref-type="bibr" rid="ref3">3</xref> </sup></p> <p>This review indicates that BLA is gaining popularity and being done more commonly at institutions worldwide.</p> <p>Although this report (Re: Letter to Editor) does not prove or disprove the use of BLA, it provides data for clinicians to use to weigh risks and benefits appropriately. 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JRMS

J Res Med Sci

Journal of Research in Medical Sciences

1735-1995 1735-7136

Medknow Publications Pvt Ltd

India

JRMS-17-896

23826024

Letter to Editor

Re: Synchronous bilateral adrenalectomy by midline incision: A reliable method for treatment of hypercortisolism

Bahrami

Faranak

Assistant professor, Department of Surgery, Al-Zahra Hospital, Isfahan, Iran

Address for correspondence:Faranak Bahrami, Department of General Surgery, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran Bahramifar@med.mui.ac.ir

September 2012

17 9 896 897

2012

This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

<p>Sir,</p> <p>After I read the Letter to Editor <sup> <xref ref-type="bibr" rid="ref1">1</xref> </sup>(Synchronous bilateral adrenalectomy by midline incision: A reliable method for treatment of hypercortisolism) and Letter to Editor <sup> <xref ref-type="bibr" rid="ref2">2</xref> </sup>Re: Tabatabaee et al. in JRMS, I found some studies which may be useful in this regard..</p> <p>Bilateral adrenalectomy either by open (BOA) or laparoscopic (BLA) approach remains a safe and definitive management for corticotrophin (ACTH)-dependent Cushing′s syndrome.</p> <p>Open adrenalectomy remains a consideration when concomitant intra-abdominal procedures are necessary in select patients with ectopic ACTH syndrome, or when laparoscopic techniques are either inappropriate or unavailable. <sup> <xref ref-type="bibr" rid="ref3">3</xref> </sup></p> <p>To date, there is a few published information that directly compares open and laparoscopic approach of bilateral adrenalectomy.</p> <p>Laparoscopic procedure for adrenalectomy has become widely accepted since its initial description in 1992. <sup> <xref ref-type="bibr" rid="ref1">1</xref> </sup>, <sup> <xref ref-type="bibr" rid="ref2">2</xref> </sup></p> <p>Although Propilia et al. (2004) <sup> <xref ref-type="bibr" rid="ref4">4</xref> </sup>and Acosta et al. (1999) <sup> <xref ref-type="bibr" rid="ref5">5</xref> </sup>found no difference in complications and in the length of hospital stay between BOA and BLA procedures, respectively, more numerous recent reports have demonstrated that laparoscopic adrenalectomy is associated with a shorter hospital stay, faster recovery, improved patient satisfaction, lower morbidity rate, favorable outcomes, and fewer perioperative complications (especially, wound related) than open adrenalectomy. <sup> <xref ref-type="bibr" rid="ref6">6</xref> </sup>, <sup> <xref ref-type="bibr" rid="ref7">7</xref> </sup>, <sup> <xref ref-type="bibr" rid="ref8">8</xref> </sup>, <sup> <xref ref-type="bibr" rid="ref9">9</xref> </sup>, <sup> <xref ref-type="bibr" rid="ref10">10</xref> </sup>, <sup> <xref ref-type="bibr" rid="ref11">11</xref> </sup>, <sup> <xref ref-type="bibr" rid="ref12">12</xref> </sup>, <sup> <xref ref-type="bibr" rid="ref13">13</xref> </sup>, <sup> <xref ref-type="bibr" rid="ref14">14</xref> </sup>, <sup> <xref ref-type="bibr" rid="ref15">15</xref> </sup>, <sup> <xref ref-type="bibr" rid="ref16">16</xref> </sup>, <sup> <xref ref-type="bibr" rid="ref17">17</xref> </sup></p> <p>Additionally, postoperative analgesic requirements have been shown to be significantly less, following BLA when compared with BOA. <sup> <xref ref-type="bibr" rid="ref3">3</xref> </sup></p> <p>The overall rates for mortality and complications from the 12 series are 2.4% and 13%, respectively. <sup> <xref ref-type="bibr" rid="ref18">18</xref> </sup>, <sup> <xref ref-type="bibr" rid="ref19">19</xref> </sup></p> <p>Hence, in experienced centers, BLA is safe and effective; more often avoiding problems associated with open approaches these being especially problematic in the patients with hypercortisolism. <sup> <xref ref-type="bibr" rid="ref3">3</xref> </sup></p> <p>This review indicates that BLA is gaining popularity and being done more commonly at institutions worldwide.</p> <p>Although this report (Re: Letter to Editor) does not prove or disprove the use of BLA, it provides data for clinicians to use to weigh risks and benefits appropriately. 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