Adrenalectomy is the surgical removal of one or both of the adrenal glands. The adrenal glands are paired endocrine glands, one located above each kidney, that produce hormones such as epinephrine, norepinephrine, androgens, estrogens, aldosterone and cortisol. Adrenalectomy is usually performed by conventional open incision, but in selected patients surgeons may use laparoscopy.
Adrenalectomy is usually advised for patients with tumors of the adrenal glands. These tumors may be malignant or benign, but all typically excrete excessive amounts of one or more hormones. This helps correct hormone imbalances and may also remove cancerous tumors that can invade other parts of the body. In certain situations when hormones produced by the adrenal glands aggravate another condition such as breast cancer, adrenalectomy may be recommended.
Extreme care has to be taken during this procedure as there are numerous blood vessels connected to the adrenal gland. The glands lie close to the vena cava, one of the body's major blood vessels and to the spleen and the pancreas.
There are four directions that can be chosen which would depend on the exact problem and the patient's body type.
In the anterior approach, the surgeon cuts into the abdominal wall. Usually the incision will be horizontal, just under the rib cage. If the surgeon intends to operate on only one of the adrenal glands, the incision will run under just the right or the left side of the rib cage. Sometimes a vertical incision in the middle of the abdomen provides a better approach, especially if both adrenal glands are involved.
In the posterior approach, the surgeon cuts into the back, just beneath the rib cage. If both glands are to be removed, an incision is made on each side of the body. Though it does not provide a view quite as clear of the surrounding structures as the anterior approach, this approach is the most direct route to the adrenal glands.
The flank approach is particularly useful in obese patients where the surgeon cuts into the patient's side. In cases where both the glands need to be removed, each side is done at a time.
The last approach involves an incision into the chest cavity, either with or without part of the incision into the abdominal cavity. It is used when the surgeon anticipates a very large tumor, or if the surgeon needs to examine or remove nearby structures as well.
This technique does not require the surgeon to open the body cavity. Instead, four small incisions (about 1/2 in diameter each) are made into a patient's flank, just under the rib cage. A laparoscope, which enables the surgeon to visualize the inside of the abdominal cavity on a television monitor, is placed through one of the incisions. The other incisions are for tubes that carry miniaturized versions of surgical tools. These tools are designed to be operated by manipulations that the surgeon makes outside the body.
Most of the preparations are the same as in other major operations. It is also taken care that hormone imbalances are taken care of. Physicians will instruct you to certain medications for days or weeks before the surgery. Problems like inadequate potassium in the blood and hypertension caused due to adrenal tumors should be treated prior to the surgery.
Most adrenal tumors can be imaged very well with a CT scan or MRI and benign tumors tend to look different on these tests than do cancerous tumors. Surgeons may order a CT scan, MRI, or scintigraphy (viewing of the location of a tiny amount of radioactive agent) to help locate exactly where the tumor is.
The day before surgery, patients will probably have an enema to clear the bowels.
Patients stay in the hospital for various lengths of time after adrenalectomy. The longest hospital stays are required for open surgery using an anterior approach. Hospital stay would be for about three days for open surgery using the posterior approach or for laparoscopic adrenalectomy.
The special concern after adrenalectomy is the patient's hormone balance. There may be several sets of lab tests to define hormone problems and monitor the results of drug treatment. In addition, blood pressure problems and infections are more common after removal of certain types of adrenal tumors.
As with most open surgery, surgeons are also concerned about blood clots forming in the legs and traveling to the lungs (venous thromboembolism), bowel problems and postoperative pain. With laparoscopic adrenalectomy, these problems are somewhat less difficult, but they are still present.
The special risks of adrenalectomy involve major hormone imbalances, caused by the underlying disease, the surgery, or both.These can include problems with wound healing itself, blood pressure fluctuations and other metabolic problems.
Other risks are typical of many operations.These include:
- Damage to adjacent organs (spleen, pancreas)
- Loss of bowel function
- Blood clots in the lungs
- Lung problems
- Surgical infections
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