Adrenalectomy :

The procedure to surgically remove one or both of the adrenal glands is known as Adrenalectomy. Adrenal glands are paired endocrine glands, one located above each kidney. Their primary function is to 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 some cases, 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.

Procedure

Open adrenalectomy

There are four directions that can be chosen which would depend on the exact problem and the patient's body type.

• The Anterior Approach: The surgeon cuts into the abdominal wall by making an incision which will usually 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
• The Posterior Approach: Here 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 clear view of the surrounding structures like in the case of an anterior approach, this approach is the most direct route to the adrenal glands
• The Flank Approach: This approach is adopted particularly in the cases of 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.

Laparoscopic adrenalectomy

This technique does not require the surgeon to open the body cavity. Instead, four small incisions (about a 1/2 inch 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.

Preparation

Most aspects of preparation are the same as with any surgery. One important factor that would be monitored closely is hormonal imbalance. This poses as a major challenge, so physicians try to correct this with medication in the days or weeks before the surgery. Adrenal tumors may cause other problems such as hypertension or inadequate potassium in the blood. If possible, these problems should also be resolved before the surgery is performed. Therefore, a patient may take specific medicines for days or weeks before 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.

Risks

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:

• bleeding
• damage to adjacent organs (spleen, pancreas)
• loss of bowel function
• blood clots in the lungs
• lung problems
• surgical infections
• pain
• extensive scarring

Recovery

Stay at the hospital would vary depending on the kind of Adrenalectomy that has been performed. The longest hospital stays are required for open surgery using an anterior approach while a stay of only 3 days would be required if the posterior approach or laparoscopic adrenalectomy is done.

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.