Adrenal Surgery (Adrenalectomy)
Traditional adrenalectomy requires a large single incision in the abdomen or back to access the adrenal glands. However, with advancement of surgical techniques, we are now able to perform the same surgery laparoscopically – using several small (approximately ½”) incisions. The benefits of laparoscopic surgery are significant and include a shorter hospital stay, less post-operative pain and blood loss, a lower chance of incisional hernia formation and improved aesthetics. Not all patients will qualify for laparoscopic surgery – this will be discussed during pre-op consultations.
Because there are two adrenal glands, it will be necessary to diagnose which is malfunctioning and also to ensure that the adrenal gland itself is the primary cause of the symptoms. Several other parts of the body can contribute to adrenal problems and its related symptoms. Tumors (benign or malignant) are the most common indications for surgery, however the tumor must be either be causing the excess hormonal production or be suspicious or malignant to remove it.
How an Adrenalectomy Works
If performed in a minimally invasive manner, your surgeon will create several small incisions through which trocars will be inserted. These trocars serve as passageways for the insertion of medical devices, including a laparoscope (high definition camera). Once the adrenal gland is located, it will carefully be separated from its connective tissue. The adrenal gland, with tumor if present, will be placed in a surgical bag and removed through one of the trocars.
Some adrenalectomies will have to be converted to an open procedure on a case by case basis for patient safety reasons. The most common criteria for a conversion to open surgery include poor visualization of the adrenal gland due to dense scar tissue, obesity or excessive bleeding and/or a larger than expected tumor (which cannot be removed through the laparoscopic incisions).
Recovery and Aftercare
Depending on the procedure itself, as well as the patient’s general health, recovery is generally quick. Patients will spend one to two days in the hospital and should be able to resume normal activity within a week to ten days. During this post-operative period, patients may have to take certain medications while the remaining adrenal gland adjusts to surgery. Some patients that undergo surgery for hyperaldosterone-related tumors may have to take blood pressure medication over the longer-term.
Risks and Considerations
Much like any surgical procedure, there are inherent risks that include abnormal bleeding, reactions to general anesthesia, injury to surrounding organs and infection. However, the risk of these conditions is relatively low when the procedure is performed by an experienced surgeon. These risks will be discussed thoroughly during pre-op consultations.