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Adrenal Gland Surgery

The procedure of removal of an adrenal gland is called an adrenalectomy. There are two adrenal glands in the body, both the right and left adrenal glands are located just above and to the right of the kidney. One or both adrenal glands may be removed by surgery depending on the nature of disease.

Hospital Stay: Hospital Stay: 2 days
Duration: Duration: 3 hrs
Cost Estimate: Cost Estimate: 3605 USD - 4853 USD These are indicative prices in Indian Hospitals

Common reasons for removal of the adrenal gland include the following:

  • Benign adrenal tumours such as Cushing disease and Conn’s syndrome
  • Pheochromocytoma
  • Adrenal cancer
  • Metastatic disease from lung, breast and other cancers.
  • Adrenal mass (enlargement) of uncertain origin – If a mass in the adrenal gland is more than 4cm large then there is a higher risk of cancer than a smaller mass.
  • Cushing’s syndrome – Removal of both adrenal glands is sometimes considered in patients who have brain pituitary tumors that produce excessive amounts of a hormone called ACTH. ACTH stimulates the adrenal to release steroids. If the pituitary tumor is not treatable by standard neurosurgical and radiation treatments, then both the adrenal glands are removed to treat Cushing syndrome.

Types of Adrenal Surgery

  • Open Adrenalectomy
    Open adrenal surgery can be done through three types of approaches: anterior, posterior, or thracoabdominal. Open adrenalectomy is preferred when there is a very large adrenal tumor or the adrenal tumor is at high risk of cancer. Patients having an open adrenalectomy will stay in the hospital for 5-10 days after surgery.
  • Laparoscopic Adrenalectomy
    Multiple small incisions are made in the abdomen, a camera and instruments are used to remove the adrenal gland. Patients will leave the hospital in a day or two following surgery.
  • Cortical Sparing Adrenalectomy
    This surgery involves removal of just the adrenal tumor and a margin of normal adrenal gland tissue surrounding the tumor. This approach is possible if the tumor is small and the tumor is clearly not cancer.The surgery approach is dependent on factors, such as size, features, and appearance of the tumor, if the patient has had previous abdominal surgeries, and patient body type.

 

Preparing for Surgery

Prior to surgery, you will need to have a pre-surgical evaluation to be sure you are healthy enough to undergo surgery. You will have blood work done and depending on your age and/or medical history may need other testing, such as an EKG or chest x-ray. If you have a history of significant cardiac or pulmonary conditions, you may need to get clearance from your medical specialist to continue with surgery.

Other Tests

Pre-operative imaging in the case of adrenal masses is critical in planning the surgical procedure. Pre-operative CT or MRI will provide critical information to the location of the mass, involvement of surrounding structures, mass size, and possibility of metastatic disease in the case of adrenal carcinoma. This imaging may also help to differentiate between a concerning mass and a simple benign tumor.

Surgery

  • You will be given general anesthesia.
  • You are placed on your back or on your side depending on how the adrenal gland is being removed.
  • You will have a foley catheter inserted into your bladder to drain your urine.
  • Also, a small tube will be inserted through your nose or your mouth into your stomach. This will keep your stomach empty and prevent nausea and vomiting.
  • You will also have one or more intravenous (IV) tubing to give you fluids.
  • If you are having a laparoscopic adrenalectomy, four to five small incisions will be made into the side of your abdomen. These small incisions are used for the laparoscopic instruments to extract the adrenal gland.
  • For an open adrenalectomy, one long incision is made in the middle or across the abdomen.
  • The incision is stitched closed and is then covered with white tapes called steri-strip tapes and a dry gauze dressing.
  • The operation generally lasts from two to four hours.

After Surgery

Recovery

Most patients will be eating, drinking, and walking around the night of their surgery. Patients that have had an open adrenalectomy may need to wait until the next day or two days to eat and drink.

Pain

Patients that have a laparoscopic adrenalectomy will have mild pain after surgery that can usually be controlled by non-narcotic pain medications. Patients that have an open adrenalectomy may require pain control with narcotics.

Incision

A light bandage consisting of a gauze pad and a clear plastic covering will be placed over your incision after surgery. This bandage may be removed 48 hours after surgery. If you have steri-strips on your incision, leave them in place until they begin to fall off naturally. If they have not fallen off in 7-10 days, you may gently remove them.

If staples were used to close your incision, leave them in place, they will be removed on your follow up clinic visit. Your incision may be sensitive so avoid tight restrictive clothing. You may feel a firm ridge directly under the incision. This is normal and will soften and go away when healing is complete usually in 3-6 months.

All incisions are sensitive to sunlight. The ultraviolet light of the sun and tanning booths will darken the scar area in the first year. Always use sunscreen.

Showering

You may shower the day after surgery. Try not to get the bandage totally soaked. Once the bandage is off, it is still OK to shower. Still, try not to totally saturate the incision. You should not go swimming or soak in a tub or hot tub until your surgeon tells you it is okay.

Diet/Swallowing

You may eat whatever you choose. You may prefer softer foods and liquids initially if you have a sore throat. Advance your diet as you see fit. Make sure you stay hydrated. Your appetite may be decreased right after surgery, but will improve with time.

Pain management at home

Take NSAIDS like ibuprofen, naproxen or acetaminophen for the first 3-5 days as needed. Take medication as directed by the surgeon.

Back to Normal Activities

  • In general, overall recovery may take 2-4 weeks and for open adrenalectomies it could be longer.
  • Walk every day and gradually increase the time and distance that you walk.
  • Avoid lifting, pushing, or pulling anything heavier than 10 pounds for 4 weeks or as directed by the surgeon to avoid hernia formation at the incision.
  • Avoid activities that strain your abdominal muscles for at least 4 weeks or as directed by the surgeon.
  • Do not do any vigorous activity for at least 4 weeks.

Signs of Infection

  • Temperature greater than 100°F for more than 24 hours
  • Swelling, tenderness, redness, unusual drainage from your incisions
  • Nausea, vomiting, or shaking chills.

The adrenal glands are two small organs, one located above each kidney. They are triangular in shape and about the size of a thumb. The adrenal glands are known as endocrine glands because they produce hormones. These hormones are involved in control of blood pressure, chemical levels in the blood, water use in the body, glucose usage, and the “fight or flight” reaction during times of stress. These adrenal-produced hormones include cortisol, aldosterone, the adrenaline hormones – epinephrine and norepinephrine – and a small fraction of the body’s sex hormones.

Diseases of the adrenal gland are relatively rare. The most common reason that a patient may need to have the adrenal gland removed is excess hormone production by a tumor located within the adrenal. Most of these tumors are small and not cancers. They are known as benign growths that can usually be removed with laparoscopic techniques. Removal of the adrenal gland may also be required for certain tumors even if they aren’t producing excess hormones, such as very large tumors or if there is a suspicion that the tumor could be a cancer, or sometimes referred to as malignant. Fortunately, malignant adrenal tumors are rare. An adrenal mass or tumor is sometimes found by chance when a patient gets an X-ray study to evaluate another problem.

In the past, making a large 6 to 12 inch incision in the abdomen, flank, or back was necessary for removal of an adrenal gland tumor. Today, with the technique known as minimally invasive surgery, removal of the adrenal gland (also known as “laparoscopic adrenalectomy”) can be performed through three or four 1/4-1/2 inch incisions. Patients may leave the hospital in one or two days and return to work more quickly than patients recovering from open surgery. Results of surgery may vary depending on the type of procedure and the patients overall condition.

Common advantages are:

  • Less postoperative pain
  • Shorter hospital stay
  • Quicker return to normal activity
  • Improved cosmetic result
  • Reduced risk of herniation or wound separation
  • Prior to the operation, some patients may need medications to control the symptoms of the tumor, such as high blood pressure.
  • 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.
  • 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.
  • 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 blood thinner, anti-inflammatory medications and large doses of Vitamin E may need to be stopped temporarily for a short time period before surgery.
  • Quit smoking and arrange for any help you may need at home.
  • The surgery is performed under a complete general anaesthesia, so that the patient is asleep during the procedure.
  • 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.

As with any operation, there is a risk of a complication. Complications during the operation may include:

  • Adverse reaction to general anaesthesia
  • High blood pressure
  • Bleeding
  • Injury to other organs
  • Wound problems, blood clots, heart attacks, and other serious complications are uncommon after laparoscopic adrenalectomy

Be sure to call your physician or surgeon if you develop any of the following:

  • Persistent fever over 101°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

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