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What is adrenal gland?
The laparoscopic removal of the right adrenal gland may be necessary because of tumors or other conditions.
The adrenal glands are triangular glands located above the kidneys. They provide essential hormones that control the body's fluid and salt regulation. They also produce hormones that control our fear, anger, blood pressure, muscle development, sexual drive and sugar metabolism. They secrete the hormone which helps the body deal with the stress. Like the kidneys, at least one adrenal gland is usually required to live a normal life.
When is laparoscopic adrenalectomy indicated?
The indications for laparoscopic adrenalectomy are as follows:
- Hormonally active tumors, including
- aldosteronomas,
- pheochromocytomas and
- cortisol-producing adrenal tumors
- Nonfunctioning tumors less than 4-6 cm in diameter
- Tumors larger than 6 cm should be removed because of an increased incidence of cancer with increasing size.
For the malignant tumors of the adrenal glands, open adrenalectomy may be preferred. The choice of surgery depends on your healthcare provider.
What is laparoscopic adrenalectomy?
Laparoscopic adrenalectomy is a surgical technique used to remove the adrenal gland without making a big incision. Removing an adrenal gland using a laparoscope is a technically demanding procedure that calls for specialized skills and training.
- Laparoscopic adrenalectomy is done under general anesthesia, and the patient’s vitals are monitored throughout the procedure. In laparoscopic right adrenalectomy, the patient would be lying on his/her right side.
- A small incision is made on the front of the abdomen or in the lower back. Additional small incisions are made through which instruments are inserted to perform the operative procedure and to hold or manipulate tissue in the abdomen.
- 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 to safely remove the tumor.
- The incisions are stitched closed and then covered with white surgical tape and a dry gauze dressing. The operation generally lasts from two to four hours.
What are the advantages of laparoscopic adrenalectomy?
Laparoscopic adrenalectomy is done on carefully selected patients who are well-suited for the procedure. Below are few common advantages of the procedure:
- Less postoperative pain and fewer medications.
- Shorter hospital stay
- Quicker return to normal activity
- Improved cosmetic result
- Reduced risk of herniation or wound separation.
- Less incidence of complications
What are the side effects of having your right adrenal gland removed?
There are not many side effects documented after adrenal gland removal. Rarely few symptoms are noticed which include:
- Low blood pressure
- Fatigue
- Elevation of serum potassium levels
- Hormone imbalance
- Infections
- Increased stress levels
- Excessive cortisol levels
The patient may need to take a synthetic form of aldosterone called Florinef (fludrocortisone) for a few weeks until natural production of aldosterone is recovered through other glands like pituitary glands. They may also need to take 20-30 mg of hydrocortisone in the form of pills by mouth each day to approximate normal cortisol production.
What is the outcome of laparoscopic adrenalectomy?
People who undergo laparoscopic surgery mostly have a faster recovery than with open surgery. Patients might be placed on blood pressure medications and other medications to treat the underlying cause of adrenal gland removal. The overall outcome of the procedure is good. Depending on the type of adrenalectomy procedure, patients can expect to recover in two to six weeks. Most patients have minimal complications and see improvements in symptoms immediately after surgery. Patients may be monitored for future occurrences, especially if the tumor was cancerous.