Laparoscopic removal of the adrenal gland

The adrenal glands are two small organs which sit on top of your kidneys.

Their main role is to produce and release hormones into the body. These hormones include ones that control blood pressure, sex hormones, regulate metabolism and contribute to the immune system function.

Laparoscopic Adrenalectomy is a minimal invasive procedure or ‘key-hole surgery’ to remove an adrenal gland which was traditionally done by the ‘open’ method. It involves the use of three or four ‘port holes’ or cuts about 1cm each which allows access to the organ. A thin tube with a light and a camera on the end and surgical instruments can then be passed through these incisions. The camera sends pictures to a screen so that the surgeon can see the adrenal gland and surrounding tissue and remove the gland. One of the incisions is enlarged to enable it to be removed.

The main reasons to remove either one or both of the adrenal glands are due to:

• Suspected or proven cancer.
• Excessive hormone production.
• Change in size.

Cancer can start in the adrenal gland, or spread (metastasise) to the adrenal gland from another site, for example the kidney.

Overproduction of the stress hormones (adrenaline and noradrenaline) is called a Phaeochromocytoma. This can cause very high blood pressure, palpitations and headaches.

If the Adrenal gland produces too much aldosterone (known as Conn’s Syndrome) it can cause high blood pressure and low potassium levels.

Cushing’s Syndrome is where one or both of the adrenal glands produce too much steroid hormone, known as Cortisol. This can cause weight gain and easy bruising and increases the risk of getting diabetes, high blood pressure and osteoporosis. Sometimes after having one or both of the adrenal glands removed patients need to go onto temporary or long-term steroids. Your doctor will discuss this with you.

Most surgery is carried out this way now. This is because:

• Avoids open surgery and large scars.
• Shorter hospital stay.
• Less risk of bleeding and infection.
• Less pain after surgery.
• Quicker recovery and earlier return to normal activities/ work.

Although this procedure has proven to be very safe, as in any surgical procedure there are risks and potential complications. The safety and complication rates are similar when compared to open surgery. The impact of these varies from patient to patient so you should discuss this with your surgeon.

Potential risks include:

• Pain: Most patients experience temporary shoulder pain and abdominal bloating for 24hrs after the operation. This is due to the gas inserted into your abdomen.
• Insertion of a temporary bladder catheter and wound drain.
• Conversion to Open Surgery: The surgical procedure may require conversion to an open operation if difficulty is encountered during the laparoscopic procedure. This could result in a larger incision (scar), longer hospital stay and possibly a longer recuperation period.
• Bleeding: all operations carry a risk of bleeding either during or after surgery. It is very rare to lose a significant amount of blood requiring a blood transfusion.
• lnfection: All patients are treated with intravenous (straight into a vein) antibiotics, prior to starting surgery to decrease the chance of infection from occurring after surgery. If you develop any signs or symptoms of infection after the surgery (fever, drainage from your incisions, pain or anything that you may be concerned about) please contact us at once. A chest infection may occur as a complication of the anaesthetic. You can help prevent this by deep breathing.
• Hernias: sometimes the deep tissue layers do not heal completely and can cause a bulge over the port site, known as a hernia. This is rare, but can result in requiring another operation to repair it.
• Tissue / Organ Injury: Although uncommon, possible injury to surrounding tissue and organs could happen. These include your bowel, kidney, vascular structures, spleen, liver, pancreas, diaphragm and gallbladder could require further surgery. Injury could possibly occur to nerves or muscles related to positioning during the operation.
• Deep vein thrombosis (DVT) / Pulmonary embolism (PE): all patients having a general anaesthetic are at risk of getting a blood clot in their lungs (PE) or legs (DVT). To reduce this risk we give you stockings to wear on your legs and encourage you to be active following surgery. We also may give you injections of a blood thinning medication.
• Sometimes it can take a while for the remaining adrenal gland to produce enough hormones for your body so you may need tests and steroid replacements to help with this. If both of your adrenal glands are removed you will need to take steroid medication for life.

Sometimes medication can stop the excessive production of hormones but they do not cure the problem and may have side effects. This type of medication does not treat cancer.

You will attend a pre-assessment clinic to assess your suitability for surgery. Blood tests, urine tests, ECG (heart reading) and infection screening e.g. MRSA will be carried out. Please bring a list of your medications with you. You will also be told what medications to continue and to stop and when to do so.

You may eat and drink as you desire the evening prior to surgery. You will have nothing to eat 6 hours before your operation and clear fluids e.g. water for 2 hours before.