Overview of Adrenalectomy | Endocrinology

Adrenalectomy

What is Adrenalectomy?

There is one adrenal gland above each of your kidneys. The adrenal glands produce different hormones that help regulate metabolism, the immune system, blood pressure, blood sugar, and other basic functions.

Most adrenal gland tumors are noncancerous (benign). You may need surgery to remove the adrenal gland if the lump is producing excess hormones or is large (more than 2 inches or 4 to 5 centimetres). You may also need surgery if the lump is precancerous (malignant) or suspected to be precancerous. This surgery is called adrenalectomy.  You might also need adrenalectomy to remove cancer that has spread (metastasized) from additional location, such as the kidney or lung.

If both adrenal glands are removed, you will need to take supplemental hormone medications. If only one gland is detached, the other will take over full function without the need for ongoing medications.

Types of adrenalectomy

Surgeons may perform adrenalectomy through minimally invasive (laparoscopic) surgery, traditional open surgery, or the use of cryoablation. The procedure they commend depends on the extent and type of tumor or the condition affecting your adrenal gland.

Minimally invasive surgery:  Endocrine surgeons are often capable to use minimally invasive (laparoscopic) surgery for tumors of the adrenal gland because the gland is relatively small. Laparoscopic surgery has many benefits, including smaller scarring, less pain and a shorter recovery period than traditional open surgery.

An alternative approach to laparoscopic surgery is endoscopic posterior adrenalectomy (PRA), in which surgeons make small incisions in your back. Surgeons sometimes use the robotic da Vinci surgical system to perform laparoscopic adrenalectomy.

  • Open surgery: Doctors usually reserve open surgery for large or cancerous (malignant) tumors. They perform open surgery using incisions and traditional tools.
  • Cryoablation: Additionally, doctors may use cryoablation to treat adrenal gland tumors. This procedure uses a CT scan to guide the insertion of a probe that freezes and destroys adrenal tumors. Interventional radiologists may use cryoablation as a treatment option for small tumors that have spread to the adrenal gland (metastasis), especially when surgery involves high risk.

How is adrenalectomy done?

The surgeon will work in one of two ways:

  • Open adrenalectomy: The surgeon may use open surgery if the lump is large or it may be cancerous. The surgeon makes a large open incision (cut) in the abdomen to remove the gland (s).
  • Laparoscopic adrenalectomy: Most commonly, the surgeon makes a few small incisions and performs a minimally invasive procedure. This method uses a laparoscope, which is a thin tube equipped with a tiny video camera so that the surgeon can see what is inside the body. Robotic surgery uses the same incisions but uses wrist tools instead of solid ones. Whether the procedure is laparoscopic or robotic, the procedure can be performed either by placing incisions on the back (posterior approach) or on the side (lateral approach).

Both procedures are equally successful, with the posterior approach providing the advantages of not entering the abdomen. The back method is also preferred in patients with a previous history of upper abdominal incisions and two-sided tumors. Due to the small working area with the posterior approach, only tumors smaller than 6 cm are approached through the back.

Does adrenalectomy remove one gland or both?

The surgeon may remove the tumor, only one gland, or both. The surgery that removes one gland is a unilateral removal of the adrenal gland. Two-sided adrenalectomy removes both glands. People with excess cortisol (Cushing’s syndrome may take a hydrocortisone supplement for about a year after surgery until the remaining gland begins producing enough hormone on its own. For other patients, testing is done after surgery to determine if the patient needs to be on a steroid substitute).

After the adrenalectomy procedure

The hospital stay after surgery is usually 4 to 5 days. The patient can return to his normal activities as soon as he feels ready. Patients are advised to avoid strenuous exercise for 6-8 weeks after surgery.

Benefits of adrenalectomy

The advantages of adrenalectomy treatment are:

  • Smaller scars
  • Less risk of hernia
  • Pain relief after the operation
  • Shortest hospital stay and recovery time

Risks of adrenalectomy

The risks associated with adrenalectomy are:

  • Hormonal imbalance is a potential risk, leading to complex health problems such as slow healing, blood pressure disorders or metabolic disorders.

Other potential risks include

  • Bleeding
  • Bowel disorders
  • Blood clots in the lungs
  • Infections
  • Pain
  • Scarring, or damage to the pancreas.

Limitations

  • Damage to neighbouring organs
  • Hernia
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