• Adrenalectomy—Laparoscopic Surgery

    Definition

    Adrenalectomy is the removal of one or both adrenal glands. There is one gland on top of each kidney. The adrenal glands make several hormones, including cortisol, aldosterone, and sex steroids.
    Adrenal Glands
    Adrenal Kidney
    Copyright © Nucleus Medical Media, Inc.

    Reasons for Procedure

    Your adrenal gland may be removed if you have any of the following:
    • Adrenal cancer
    • Diseases of the adrenal gland, causing it to make too much of a hormone (eg, excess cortisol— Cushing's syndrome , excess aldosterone—Conn’s syndrome, or excess adrenaline— pheochromocytoma )
    • A large adrenal mass
    • An adrenal mass that cannot be identified with a needle biopsy

    Possible Complications

    Complications may include:
    • Insufficient cortisol production
    • Decreases in blood pressure
    • Bleeding
    • Infections in the wound, urinary tract, or lungs
    • Blood clots in the legs
    • Injury to nearby organs or structures
    • Adverse reaction to anesthesia
    Factors that may increase the risk of complications include:
    • Age: 60 or older
    • Obesity
    • Long-standing cortisol excess
    • Smoking
    • Poor nutrition
    • Recent or chronic illness
    • Heart or lung problems
    • Alcoholism
    • Use of certain medicines (eg, blood pressure pills, muscle relaxants, tranquilizers)
    • Use of street drugs (eg, LSD, hallucinogens, marijuana, or cocaine)
    Be sure to discuss these risks with your doctor before the surgery.

    What to Expect

    Prior to Procedure

    Your doctor will likely do some or all of the following:
    • Physical exam, blood tests, urine tests
    • Abdominal ultrasound —a test that uses sound waves to find specific places in the abdomen
    • CT scan of the abdomen —a type of x-ray that uses a computer to make pictures of the kidneys and/or adrenal glands
    • MRI scan —a test that uses magnetic waves to make pictures of the kidneys and/or adrenal glands
    • CT scan of the head—to examine the pituitary gland (this gland controls the adrenal glands)
    • Nuclear scan—a small amount of radioactive material is injected and pictures are taken to determine if the tumor is cancerous
    • Give certain medicines to determine why the adrenal gland is not working correctly
    Let your doctor know which medicines you are taking. You may be asked to stop taking or adjust the dose of certain medicines (eg, aspirin , warfarin , clopidogrel ).
    In the days leading up to your procedure:
    • Arrange for a ride home and for help at home.
    • The night before, eat a light meal. Do not eat or drink anything after midnight.
    • You may be given laxatives and/or an enema. These will clean out your intestines.
    You will need to go to the hospital sooner if your blood pressure is not controlled. The doctor will need to stabilize your blood pressure.

    Anesthesia

    General anesthesia will be used. You will be asleep.

    Description of the Procedure

    You will be given IV fluids, antibiotics, and steroid medicines. With the laparoscopic approach, the doctor will make 3-4 small incisions in the abdomen. A tiny camera will be passed through one of these openings. To allow a better view, the abdomen will be filled with gas. Other tools will be used to separate the adrenal gland from the kidney. The gland will then be removed through an incision. Stitches or staples will be used to close the incisions. Small bandages will be placed.
    The doctor may place a tiny, flexible tube where the gland was removed. This tube will drain fluids that may build up. It will be removed within one week.
    The doctor may need to switch to an open surgery if there are any problems.

    Immediately After Procedure

    You will be monitored in the recovery room.

    How Long Will It Take?

    1-½–3-½ hours

    How Much Will It Hurt?

    You will have pain or soreness. Your doctor will give you pain medicine.

    Average Hospital Stay

    2-3 days

    Postoperative Care

    At the Hospital
    • You may be nauseated for a few hours after surgery. You may have a tube placed down your nose and into your stomach. This is to drain fluids and stomach acid. You will be able to eat and drink once the tube is removed and you are no longer nauseated.
    • You may be given special compression stockings to decrease the possibility of blood clots forming in your legs.
    • Your body may be making less steroid hormones. Your doctor may start you on steroid medicines .
    At Home
    Recovery time may be 7-10 days. To help ensure a smooth recovery:
    • Your doctor will monitor your steroid hormones and make sure that you have the right dose of medicine.
    • Weigh yourself daily. Report to your doctor any weight gain of two or more pounds over 24 hours. This may indicate that you are retaining fluid.
    • Ask your doctor about when it is safe to shower, bathe, or soak in water.
    • Monitor your blood pressure regularly.
    • Increase your physical activity according to your doctor's instructions. This will help you avoid respiratory problems and improve the recovery of your digestive system.
    • Follow your doctor’s instructions .
    Recovery time may be 7-10 days. To help ensure a smooth recovery:
    • Your doctor will monitor your steroid hormones and make sure that you have the right dose of medicine.
    • Weigh yourself daily. Report to your doctor any weight gain of two or more pounds over 24 hours. This may indicate that you are retaining fluid.
    • Ask your doctor about when it is safe to shower, bathe, or soak in water.
    • Monitor your blood pressure regularly.
    • Increase your physical activity according to your doctor's instructions. This will help you avoid respiratory problems and improve the recovery of your digestive system.
    • Follow your doctor’s instructions .

    Call Your Doctor

    After you leave the hospital, contact your doctor if any of the following occurs:
    • Signs of infection, including fever and chills
    • Redness, swelling, increasing pain, excessive bleeding, or any discharge from the incision site
    • Nausea and/or vomiting
    • Pain that you cannot control with your medicine
    • Pain, burning, urgency, or frequency of urination; persistent bleeding in the urine
    • Cough, shortness of breath, or chest pain
    • Pain and/or swelling in your feet, calves, or legs
    • Headaches
    • Lightheadedness or dizziness
    • Any new symptom
    In case of an emergency, call for medical help right away.

    RESOURCES

    American Urological Association http://www.urologyhealth.org/

    National Institute of Diabetes and Digestive and Kidney Diseases http://www.niddk.nih.gov/

    CANADIAN RESOURCES

    Canadian Urological Association http://www.cua.org/

    The Kidney Foundation of Canada: British Columbia Branch http://www.kidney.bc.ca/

    References

    Agha A, von Breitenbuch P, Gahli N, et al. Retroperitonenscopic adrenalectomy: lateral versus dorsal approach. J Surg Oncol . 2008;97:90-3.

    Gallagher SF, Wahi M, Haines KL, et al. Trends in adrenalectomy rates, indications, and physician volume: A statewide analysis of 1816 adreanlectomies. Surgery . 2007;142:1011-21.

    Hanssen WE, Kuhry E, Casseres YA. Safety and efficacy of endoscopic retroperitoneal adrenalectomy. Br J Surg . 2006;93:715-9.

    Jossart GH, Burpee SE, Gagner M. Surgery of the adrenal glands. Endocrinol Metab Clin North Am . 2000;29:57-68.

    Munver R, Del Pizzo JJ, Sosa RE. Adrenal-preserving minimally invasive surgery: the role of laparoscopic partial adrenalectomy, cryosurgery, and radiofrequency ablation of the adrenal gland. Curr Urol Rep . 2003;4:87-92.

    Pamaby CN. The role of laparoscopic adrenalectomy for adrenal tumours of 6 cm or greater. Surg Endosc . 2008;22:617-21.

    Rakel RE, Conn HF. Conn's Current Therapy 2000 . Houston, TX: WB Saunders Co.; 1999.

    Thompson SK, Hayman AV, Ludlam WH, et al. Improved quality of life after bilateral laparoscopic adrenalectomy for Cushing’s disease: a 10-year experience. Ann Surg . 2007;245:790-94.

    Townsend C, Beauchamp DR, et al. Sabiston Textbook of Surgery . 16th ed. WB Saunders; 2001.

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