What Is Laparoscopic Adrenalectomy ?
The procedure performed in order to remove an adrenal gland is called an Adrenalectomy.
There are two adrenal glands in the body on the right and left sides. Benign or cancerous tumors on your adrenal glands are the most common reason for an Adrenalectomy.
Surgeons may remove one or both of your adrenal glands if they contain a tumor. If you only need one adrenal gland removed, the remaining adrenal gland can take over and provide full functioning.
If one or both of your adrenal glands produces too much of a hormone, you may need an Adrenalectomy. Excess hormone production is a symptom of a tumor in your adrenal glands.
Most important is that the incision allows the systematic removal of all the lymph nodes at risk of harboring cancer. This will be done by identifying and preserving all the major structures in the neck and by removing all the fat and lymph nodes that fill up the rest of the neck contents.
In some cases, some major structures may need to be removed because of invasion of cancer. Such structures could include the sternocleidomastoid muscle, the internal jugular vein and the spinal accessory nerve.
The advance of laparoscopy has led to a surgical revolution that enabled surgeons to treat adrenal pathologies with decreased risk and allow patients the added benefit of a shortened recuperation. The use of laparoscopy in adrenal surgery is currently the standard of care and many new surgical approaches are actively being developed. Meticulous surgical dissection and increasing surgeon experience will help to maintain the current low complication rates.
Along with the popularization of LAPAROSCOPIC ADRENALECTOMY, there has been a surge in Adrenal Surgery. This is in part due to the identification of adrenal lesions on radiographic studies performed for unrelated conditions, deemed “incidental findings”, by means of Computed Tomography (CT). It is estimated that adrenal lesions are found in up to 5% of CT scans obtained for unrelated indication.
Common indications for LAPAROSCOPIC removal of the adrenal gland are the following:
THE PROCEDURE
Our surgeons at Salus perform this procedure using 2 surgical approaches:
OPEN ADRENALECTOMY
If your adrenal glands or the tumors on them are especially large, your surgeon may opt for an open procedure.
In an open adrenalectomy, the surgeon makes large incisions under your ribcage or on the sides of your body, between 6 to 12 inches to remove an adrenal gland tumor. These incisions allow the surgeon access to the glands and the blood vessels attached to them.
The surgeon will disconnect each adrenal gland from the surrounding blood vessels and tissue.
The surgeon will then tie off the blood vessels to prevent excessive bleeding, and take the adrenal glands out of your body.
Your surgeon will rinse your abdominal cavity with a sterile saline solution before closing the wounds. Then they will close the incisions with stitches.
LAPAROSCOPIC ADRENALECTOMY
THE PROCEDURE
You will be put completely to sleep with general anesthesia for this procedure.
Laparoscopic Adrenalectomy is a more common approach than the traditional open procedure and is the procedure of choice for benign (non-cancerous) adrenal tumors, with a high success rate.
In this procedure three to five small incisions of about 1/4-1/2 inch long are made to insert a video chip camera and long tubes called ports through which long instruments are introduced for the surgery into the abdomen.
The video camera projects an image of the inside of the abdomen on a television monitor and the surgeon then performs the surgery while visualizing the procedure on the TV monitor. This lets your surgeon see your abdominal cavity on a monitor. They will fill your abdominal cavity with gas to help the doctor see the adrenal glands clearly.
Using instruments inserted into the incisions, the surgeon will disconnect the adrenal glands and cauterize the blood vessels. They will remove the adrenal glands from your body through a plastic bag that the doctor inserts into your abdominal cavity.
The procedure normally takes between 90-120 minutes to perform.
Advantages of Laparoscopic Procedures
PREPARATION FOR SURGERY
Before traveling to Cyprus, as part of your surgery preparation you will complete a detailed specific questionnaire, which will allow our doctors to determine your eligibility for Minimally Invasive Adrenalectomy Surgery.
Ten days prior to your arrival in Cyprus, you will receive all the necessary pre operative instructions, to prepare yourself both physically and mentally for your chosen procedure.
Before your departure your records will be reviewed thoroughly by our surgeon. This includes X-rays and a complete medical and surgical history as well as your specific issues.
After traveling to Cyprus, a new set of X-rays will be taken as well as an in person physical examination. Two of the tests you may have are a CT scan and an Ultrasound.
The surgeon and anesthetist will also go through you medical and surgical issues with you. During this visit, your surgeon will discuss your procedure and answer any questions.
Preparation for the hospital
Here are a few things to keep in mind as you pack and prepare for the hospital and recuperation:
Clothing
Getting dressed in the morning helps you feel better, so be sure to bring some comfortable clothing to the hospital:
Morning of surgery
Bring all your medicines in their original containers with you to the hospital. You will meet with the anesthesiologist. This doctor will talk to you about general anesthesia. This is a controlled sleep while the surgery is being done so you will not feel any pain or remember the surgery. You will have an IV or intravenous line put in to give you fluid and medicine during your surgery. When it is time for you to go to surgery, your family will be asked to wait in the waiting area. Your doctor will talk to your family there after your surgery is done.
RECOVERY AFTER SURGERY
When you wake up after your surgery, you will be in the recovery room. You will stay there until you are awake and your pain is under control. Most patients return to their room after a few hours, but some will need to stay overnight for observation.
You will receive oxygen through a thin tube called a nasal cannula that rests below your nose. A nurse will be monitoring your body temperature, pulse, blood pressure, and oxygen levels.
You will have an analgesia pump device to deliver pain medication into your IV or epidural space (in your spine). You will also have compression boots on your lower legs to help your circulation. They will be taken off when you are able to walk.
Your surgeon may place a small drain coming out of your skin, to drain any blood and/or fluid that might accumulate.
You will most likely be tired and a bit sore for a few days. You may have pain not only from your incision, but also from muscle soreness in your upper back and shoulders. This is from the positioning in the operating room during the surgery. You will have liquid pain medicine in the hospital and a prescription for pain pills at home.
If you have a laparoscopic adrenalectomy, you might also feel some cramping or bloating caused by the gas in your abdomen.
You may have a sore throat. This is a result of the placement of anesthesia tubes during surgery. Throat lozenges and spray usually help.
Your neck may be slightly swollen as well. You may feel like you have a lump in your throat when you swallow. This will improve after a few days but may continue for a week or so.
Hospital discharge and home instructions
If you have an Open Adrenalectomy, you will probably stay in the hospital for four or five days. You can usually go home two to three days after a Laparoscopic Adrenalectomy. Your surgeon will schedule a follow-up appointment with you two weeks after the surgery.
Before leaving the hospital, our surgeon and staff will help you adjust to recovery in every way possible. You will receive specific instructions and precautions from your surgeon and nursing staff and they will show you safe techniques of simple activities like getting in and out of bed, bathing, going to the bathroom etc.
You will be able to leave the hospital when you are:
LIFE AFTER SURGERY
These guidelines give you an overview of what you may expect as part of your care after you leave the hospital. Be sure to follow your surgeon’s discharge instructions if they are different from what is listed here:
If you notice sudden swelling in your neck contact our surgeon immediately. You may notice numbness and tingling of your fingers or around your mouth.
Medications
Your medicines: Take the medicines you were taking before surgery, unless your surgeon has made a change.
Your surgeon will order a prescription pain medicine for you after surgery. As your pain lessens, over the counter pain medicines such as acetaminophen or ibuprofen can be used. They can also be used instead of your prescription for mild pain.
Prescription pain medicines can cause constipation. Your doctor may order a stool softener to prevent this. You should be back to your normal bowel routine in about 2 weeks. If the stool softener does not work, take Milk of Magnesia. If you still are not getting relief, call your surgeon.
FOLLOW-UP
Follow-up after surgery is extremely important and our surgeons at Salus are committed to providing all the post surgical care you need.