Adrenalectomy -- Laparoscopic Surgery

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. The adrenal glands also make adrenaline and noradrenaline in small amounts.
Adrenal Glands
Adrenal Kidney
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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 such as Cushings syndrome, Conns syndrome, or pheochromocytoma
  • A large adrenal mass
  • An adrenal mass that cannot be identified with a needle biopsy

Possible Complications

Problems from the procedure are rare, but all procedures have some risk. Your doctor will review potential problems, like:
  • 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
Before your procedure, talk to your doctor about ways to manage factors that may increase your risk of complications such as:
  • Smoking
  • Drinking
  • Chronic diseases, such as diabetes or obesity
  • Long-standing cortisol excess
  • Smoking
  • Poor nutrition
  • Recent or chronic illness
  • Heart or lung problems
  • Alcoholism
  • Use of certain medicines such as blood pressure pills, muscle relaxants, tranquilizers, sleeping pills, insulin, steroids, sedatives, or hypnotic agents
  • Use of illegal drugs such as LSD, hallucinogens, marijuana, or cocaine

What to Expect

Prior to Procedure

Your doctor will likely do some or all of the following:
Let your doctor know which medications you are taking. You may be asked to stop taking or adjust the dose of certain medications, such as:
  • Anti-inflammatory drugs
  • Blood thinners
  • Antiplatelets
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.
Your doctors may need to admit you to the hospital before your planned procedure if your blood pressure has not been well controlled with medication. This will allow more aggressive treatment to stabilize your blood pressure. It will also ensure that you have enough fluid in your body to prevent blood pressure problems after the surgery is done.

Anesthesia

General anesthesia will be used. You will be asleep during the procedure.

Description of the Procedure

You will likely be given IV fluids, antibiotics, and medications that depend on the condition that is being treated.
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.
A tiny, flexible tube may be placed 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?

1½–3½ hours

How Much Will It Hurt?

Anesthesia will prevent pain during surgery. Pain and discomfort after the procedure can be managed with medications.

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 after 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 substantially less natural steroid hormones. Your doctor may start you on steroid medications immediately after surgery. The dose will be gradually reduced.
Preventing Infection
During your stay, the hospital staff will take steps to reduce your chance of infection, such as:
  • Washing their hands
  • Wearing gloves or masks
  • Keeping your incisions covered
There are also steps you can take to reduce your chance of infection, such as:
  • Washing your hands often and reminding your healthcare providers to do the same
  • Reminding your healthcare providers to wear gloves or masks
  • Not allowing others to touch your incision
At Home
Recovery time may be 7-10 days. To help ensure a smooth recovery:
Recovery time may be 7-10 days. To help ensure a smooth recovery:
  • Your doctor will monitor your steroid and hormone levels and make sure that you have the right dose of medication.
  • 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.

Call Your Doctor

Call your doctor if any of the following occur:
  • Signs of infection, including fever and chills
  • Redness, swelling, increasing pain, excessive bleeding, or any discharge from the incision site
  • Persistent nausea and/or vomiting
  • Pain that you cannot control with your medication
  • Pain, burning, urgency, or frequency of urination; blood in the urine
  • Cough, shortness of breath, or chest pain
  • Pain and/or swelling in your feet, calves, or legs
  • Headaches
  • Lightheadedness
  • Any new symptom
If you think you have an emergency, call for medical help right away.

RESOURCES

Urology Care Foundation 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

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

References

Agha A, von Breitenbuch P, et al. Retroperitonenscopic adrenalectomy: lateral versus dorsal approach. J Surg Oncol. 2008;97:90-93.

Gallagher SF, Wahi M, Haines KL, et al. Trends in adrenalectomy rates, indications, and physician volume: A statewide analysis of 1816 adreanlectomies. Surgery. 2007;142:1011-1021.

Hanssen WE, Kuhry E, et al. Safety and efficacy of endoscopic retroperitoneal adrenalectomy. Br J Surg. 2006;93:715-719.

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

Munver R, Del Pizzo JJ, et al. 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;22:617-621.

Thompson SK, Hayman AV, et al. Improved quality of life after bilateral laparoscopic adrenalectomy for Cushing’s disease: a 10-year experience. Ann Surg. 2007;245:790-794.

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