Every individual has two triangle-shaped adrenal glands, one of which is located atop each kidney. Each gland is made up of two parts, namely, an outer layer called the adrenal cortex and a center called the adrenal medulla. The adrenal cortex produces important hormones, such as steroids, that help the body balance water and salt and maintain normal blood pressure. Catecholamines, as well as the hormones epinephrine, norepinephrine, and dopamine, are produced by the adrenal medulla.
Although humans have two adrenal glands, only one normal gland is required to provide adequate hormonal function. When both glands must be removed, patients must take cortisone and hydrocortisone steroid supplements.
Tests to diagnose adrenal gland tumours or growths include:
- Blood or urine tests measure adrenal hormones that could indicate the presence of adrenal gland tumours.
- Needle biopsy (core biopsy) is a minor procedure that involves removing a tissue sample from the adrenal gland for observation.
- A metaiodobenzylguanidine (MIBG) scan is a diagnostic test that uses a radioisotope and scanner to check for tumours affecting nervous tissue.
- Adrenal vein sampling is considered a gold standard assessment for detecting localized adenomas that secrete aldosterone.
Before the Procedure
- The doctor advises medical investigations such as blood tests, urine tests, MIBG scans and adrenal vein sampling.
- You should fast for 8 hours the night before the surgery.
- On the morning of the surgery, you may take medications advised by your doctor with just a sip of water.
- A few medications may need to be stopped before the surgery. These include blood thinners, supplements, and medications that affect your immune system.
- You might need to start taking medications to control the symptoms of the tumor before the surgery.
- You must begin to take medicines to control heart rate and blood pressure if you have a pheochromocytoma.
- You may need potassium if you have an aldosteronoma. This type of tumor can cause low levels of this electrolyte. If you have Cushing syndrome, you will require extra cortisol medication on the day of surgery. You will require additional cortisol medication until your remaining adrenal gland returns to normal function. This usually takes a few months.
During the Procedure
The two main methods to perform adrenalectomy surgery are minimally invasive or open surgery. The most common minimally invasive surgery is a laparoscopic adrenalectomy to remove the adrenal gland using a small camera and special instruments. When a patient is advised to have an adrenalectomy, the approach chosen is based on the characteristics of the tumor, such as type, size, appearance on imaging tests, and whether or not the patient has had prior abdominal surgery.
- A laparoscopic adrenalectomy removes the adrenal gland through three or four very small incisions (each about 1/4 to 1/2 inch in size) using a small camera and special instruments. Laparoscopic adrenalectomy provides the shortest recovery time and the least amount of postoperative pain.
- Tumors smaller than 10 cm in size with a lower risk of being adrenocortical cancer can usually be removed laparoscopically.
- Most patients will be discharged from the hospital within a day or two of the adrenalectomy surgery.
- Sometimes, laparoscopic operations must be converted to the traditional open incision. The most common reasons for converting to an open operation are signs of cancer, difficult anatomy, unexpected findings, a tumor that is larger than expected, and a tumor that is invading into surrounding structures.
Surgeons perform mainly two types of laparoscopic adrenalectomy according to the size of the tumor:
Laparoscopic transabdominal approach
Three or four very small incisions in the abdomen are made just below the ribcage in the front to access the adrenal gland through the abdominal cavity. This is an excellent treatment option for tumors of all sizes and types.
Laparoscopic retroperitoneal approach (Posterior retroperitoneoscopic adrenalectomy)
Three small incisions are made just below the ribcage in the back to access the adrenal gland from outside the abdominal cavity (via the retroperitoneum). This method works well for tumors that are less than 6 cm in size and for patients who have undergone abdominal surgery in the past.
Open Adrenalectomy :An open adrenalectomy is a surgical procedure that involves making an incision in the abdomen. This type of surgery treats most adrenal cancers that require a larger incision because they must be removed in one piece to prevent the disease from spreading throughout the abdomen.
After the Procedure
- Once your surgery is completed, you will be taken to the recovery room. After you are fully awake and your vital signs are stable, you will be moved to your hospital room.
- Pain medication is administered.
- You may have a urinary catheter to drain your bladder for approximately one day after the surgery. It is normal to have blood-tinged urine for a few days after your surgery.
- An IV is a small tube that is inserted into your vein to deliver fluids and keep you hydrated; it also allows you to receive medication.
- You will be expected to do some simple breathing exercises to help prevent respiratory infections. Deep breathing and coughing is an important part of your recovery, which helps to prevent pneumonia and other pulmonary complications. The hospital stay for most patients is approximately 1-2 days.
Complications may occur with any surgical procedures during medical care or afterwards. Complications of adrenal gland removal can include:
- A reaction to general anesthesia
- High or low blood pressure
- Injury to nearby organs and structures
- Infection or problems with your incisions healing
- Blood clots formation,heart attacks, and complications with your lungs can rarely occur.
Care at Medicover
At Medicover Hospital, we have an eminent team of urologists and general surgeons to perform adrenalectomy with precision for all our patients. We offer top-notch facilities, the latest treatment protocols and advanced technologies, which has made us one of the best hospitals in India. We are one of the best adrenalectomy procedure specialists to provide the best treatments at affordable costs.