What is Adrenal Surgery?
Adrenal surgery involves the removal of one or both adrenal glands. The adrenal glands are paired endocrine glands located above each kidney. The surgical procedure of adrenal gland removal is known as an adrenalectomy. Adrenalectomy can be performed either with laparoscopic technique or open surgery.
Procedure of Laparoscopic Adrenalectomy
Laparoscopic adrenalectomy is usually indicated for non-cancerous (benign) adrenal tumors or malignant tumor-like mass within the adrenal glands.
A small incision is made in the flank (side of the body, between the ribs and the hip) through which a laparoscope (a thin telescope-like instrument) is inserted. The laparoscope is attached to a tiny video camera that enables your surgeon to visualize an enlarged view of the site of operation on the television monitor. Carbon dioxide gas is introduced into the abdominal cavity to inflate it and give a clear view of the operating area. Further, two or three small incisions are made through which surgical instruments are inserted to perform the adrenalectomy procedure. After the removal of the adrenal gland, the skin incisions will be sutured and covered with a surgical dressing.
When performing open adrenalectomy, your surgeon may choose from three different approaches: anterior, posterior, or thoracoabdominal.
The anterior approach is most commonly used and involves a vertical incision made in the middle of the abdomen or a diagonal incision just under the ribcage. The surrounding structures are moved apart to expose the adrenal glands. As this approach provides better exposure, it is ideal for large-sized adrenal tumors, particularly if a malignant tumor is suspected and removal of surrounding organs is invaded by cancer.
In the posterior approach, a curved incision is made on the side of the gland to be removed. The surrounding muscles are moved aside using retractors. During this approach, a part of the lowest rib may also be removed. This approach does not provide a wider and complete view of the surrounding structures as with the anterior approach. Hence, it is not useful in conditions with larger tumors and the possibility of malignancy which may require the removal of additional organs.
The thoracoabdominal approach is considered when the tumors are very large and invade the surrounding organs or veins that drain the adrenal gland. In this technique, a large incision is made, which extends through the abdomen and the chest to provide wide exposure to the area. This approach may cause increased postoperative pain and lung complications. Risks and Complications of Laparoscopic Adrenalectomy
The risks of complications are higher with open surgery compared to the laparoscopic surgical procedure. Possible complications of adrenal surgery include lung problems, wound infection, bleeding, scarring, the formation of blood clots in the leg veins which may travel to the lungs, adrenal insufficiency (inability to produce enough cortisol), and damage to blood vessels and adjacent organs (spleen, liver, pancreas).
What are the Advantages of Laparoscopic Adrenalectomy when compared to Open Adrenalectomy?
The advantages of laparoscopic adrenalectomy include less post-operative pain, a shorter hospitalization period, minimal scars, reduced chronic pain from nerve injury, minimal risk of developing hernia, and fast recovery with a much quicker return to normal activity.
