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Laparoscopic Adrenal Gland Removal

  • Pheochromocytomas produce excess hormones that can cause very high blood pressure and periodic spells characterized by severe headaches, excessive sweating, anxiety, palpitations, and rapid heart rate that may last from a few seconds to several minutes.
  • Aldosterone producing tumors cause high blood pressure and low serum (blood) potassium levels. In some patients this may result in symptoms of weakness, fatigue, and frequent urination.
  • Cortisol producing tumors cause a syndrome termed Cushing's syndrome that can be characterized by obesity (especially of the face and trunk), high blood sugar, high blood pressure, menstrual irregularities, fragile skin, and prominent stretch marks. Most cases of Cushing's syndrome, however, are caused bysmall pituitary tumors and are not treated by adrenal gland removal. Overall, adrenal tumors account for about 20% of cases of Cushing's syndrome.
  • An incidentally found mass in the adrenal may be any of the above types of tumors, or may produce no hormones at all. Most incidentally found adrenal masses do not make excess hormones, cause no symptoms, are benign, and do not need to be removed. 
  • Surgical removal of incidentally discovered adrenal tumors is indicated only if:
    • The tumor is found to make excess hormones
    • Is large in size (more than 4-5 centimeters or 2 inches in diameter)
    • If there is a suspicion that the tumor could be malignant.

 

Adrenal Gland Cancers

Adrenal gland cancers (adrenal cortical cancer) are rare tumors that are usually very large at the time of diagnosis. Removal of these tumors is usually done by open adrenal surgery.

 

Contraindications to Laproscopic Approach

  • Less postoperative pain
  • Shorter hospital stay
  • Quicker return to normal activity
  • Improved cosmetic result
  • Reduced risk of herniation or wound separation


Patients with a pheochromocytoma will need to be started on special medications
several days prior to surgery to control their blood pressure and heart rate.

 

Patients with an aldosterone-producing tumor may need to have their serum
potassium checked and take extra potassium if the level is low.

 

Patients with Cushing's syndrome will need to receive extra doses of cortisone
medication on the day of surgery and for a few months afterwards until the remaining adrenal gland has resumed normal function.

 

Preparing for your surgery:

  • Preoperative preparation includes blood work, medical evaluation, chest x-ray and an EKG depending on your age and medical condition.
  • After your surgeon reviews with you the potential risks and benefits of the operation, you will need to provide written consent for surgery.
  • Blood transfusion and/or blood products may be needed depending on your condition.
  • Your surgeon may request that you completely empty your colon and cleanse your intestines prior to surgery. 
  • You may be requested to drink clear liquids, only, for one or several days prior to surgery.
  • It is recommended that you shower the night before or morning of the operation.
  • After midnight the night before the operation, you should not eat or drink anything except medications that your surgeon has told you are permissible to take with a sip of water the morning of surgery.
  • Drugs such as aspirin, blood thinners, anti-inflammatory medications (arthritis medications) and large doses of Vitamin E will need to be stopped temporarily for several days to a week prior to surgery.
  • Diet medication or St. John's Wort should not be used for the two weeks prior to surgery.
  • Quit smoking and arrange for any help you may need at home.
  • The surgery is performed under a complete general anesthesia, so that the patient is asleep during the procedure.

 

What to expect during surgery:

  • A cannula (a narrow tube-like instrument) is placed into the abdominal cavity in the upper abdomen or flank just below the ribs.
  • A laparoscope (a tiny telescope) connected to a special camera is inserted through the cannula. This gives the surgeon a magnified view of the patient's internal organs on a television screen.
  • Other cannulas are inserted which allow your surgeon to delicately separate the adrenal gland from its attachments. 
  • Once the adrenal gland has been dissected free, it is placed in a small bag and is then removed through one of the incisions. It is almost always necessary to remove the entire adrenal gland in order to safely remove the tumor.
  • After the surgeon removes the adrenal gland, the small incisions are closed.


Complications:

  • Obesity
  • A history of prior abdominal surgery causing dense scar tissue
  • Inability to visualize the adrenal gland clearly
  • Bleeding problems during the operation
  • Large tumor size (over 3 or 4 inches in diameter)

 

What To Expect after surgery

  • After laparoscopic adrenal gland removal, most patients can be cared for on a regular surgical nursing unit.
  • Occasionally, a patient with a pheochromocytoma may require admission to an intensive care unit after surgery to monitor their blood pressure. 
  • Most patients can de discharged from the hospital within one or two days after surgery.
  • Patients with an aldosterone-producing tumor will need to have their serum potassium level checked after surgery and may need to continue to take medications to control their blood pressure. 
  • Patients with cortisol-producing tumors and Cushing's syndrome will need to take prednisone or cortisol pills after surgery. The dose is then tapered over time as the remaining normal adrenal gland resumes adequate production of cortisol hormone.
  • Patients are encouraged to engage in light activity while at home after surgery. Patients can remove any dressings and shower the day after the operation.
  • Post-operative pain is generally mild and patients may require a pain pill or pain medication.
  • Most patients can resume normal activities within one week, including driving, walking up stairs, light lifting,and work.
  • You should call and schedule a follow-up appointment within 2 weeks after your operation.

 

Call your surgeon if the following symptoms persist:

  • High blood pressure
  • Bleeding
  • Injury to other organs
  • Wound problems, blood clots, heart attacks, and other serious complications are uncommon after laparoscopic adrenalectomy
  • Persistent fever over 101 degrees F (39 C)
  • Bleeding
  • Increasing abdominal swelling
  • Pain that is not relieved by your medications
  • Persistent nausea or vomiting
  • Chills
  • Persistent cough or shortness of breath
  • Purulent drainage (pus) from any incision
  • Redness surrounding any of your incisions that is worsening or getting bigger
  • You are unable to eat or drink liquids