Adrenalectomy—Laparoscopic Surgery

by Editorial Staff And Contributors

Definition

Adrenalectomy is the removal of one or both adrenal glands. There is one gland on top of each kidney. The adrenal glands make several hormones, including cortisol, aldosterone, and sex steroids. The adrenal glands also make adrenaline and noradrenaline in small amounts.

Adrenal Glands

Adrenal Kidney
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Reasons for Procedure

Your adrenal gland may be removed if you have any of the following:

Possible Complications    TOP

Complications may include:

  • Insufficient cortisol production
  • Decreases in blood pressure
  • Bleeding
  • Infections in the wound, urinary tract, or lungs
  • Blood clots in the legs
  • Injury to nearby organs or structures
  • Adverse reaction to anesthesia

Factors that may increase the risk of complications include:

  • Increased age
  • Obesity
  • Long-standing cortisol excess
  • Smoking
  • Poor nutrition
  • Recent or chronic illness
  • Heart or lung problems
  • Alcoholism
  • Use of certain medicines such as blood pressure pills, muscle relaxants, tranquilizers
  • Use of illegal drugs such as LSD, hallucinogens, marijuana, or cocaine

What to Expect    TOP

Prior to Procedure

Your doctor will likely do some or all of the following:

Let your doctor know which medications you are taking. You may be asked to stop taking or adjust the dose of certain medications, such as:

  • Aspirin or other anti-inflammatory drugs
  • Blood-thinning medications
  • Anti-platelet medication

In the days leading up to your procedure:

  • Arrange for a ride home and for help at home.
  • The night before, eat a light meal. Do not eat or drink anything after midnight.
  • You may be given laxatives and/or an enema. These will clean out your intestines.

Your doctors may need to admit you to the hospital before your planned procedure if your blood pressure has not been well-controlled with medication. This will allow more aggressive treatment to stabilize your blood pressure. It will also ensure that you have enough fluid in your body to prevent blood pressure problems after the surgery is done.

Anesthesia

General anesthesia will be used. You will be asleep.

Description of the Procedure

You will likely be given IV fluids, antibiotics, and medications that depend on the condition that is being treated.

With the laparoscopic approach, the doctor will make 3-4 small incisions in the abdomen. A tiny camera will be passed through one of these openings. To allow a better view, the abdomen will be filled with gas. Other tools will be used to separate the adrenal gland from the kidney. The gland will then be removed through an incision. Stitches or staples will be used to close the incisions. Small bandages will be placed.

A tiny, flexible tube may be placed where the gland was removed. This tube will drain fluids that may build up. It will be removed within one week.

The doctor may need to switch to an open surgery if there are any problems.

Immediately After Procedure

You will be monitored in the recovery room.

How Long Will It Take?

1½–3½ hours

How Much Will It Hurt?

You will have pain or soreness. Your doctor will give you pain medicine.

Average Hospital Stay

2-3 days

Postoperative Care

At the Hospital

  • You may be nauseated for a few hours after surgery. You may have a tube placed down your nose and into your stomach. This is to drain fluids and stomach acid. You will be able to eat and drink after the tube is removed and you are no longer nauseated.
  • You may be given special compression stockings to decrease the possibility of blood clots forming in your legs.
  • Your body may be making substantially less natural steroid hormones. Your doctor may start you on steroid medications immediately after surgery. The dose will be gradually reduced.

At Home

Recovery time may be 7-10 days. To help ensure a smooth recovery:

  • Your doctor will monitor your steroid and hormone levels and make sure that you have the right dose of medicine.
  • Weigh yourself daily. Report to your doctor any weight gain of two or more pounds over 24 hours. This may indicate that you are retaining fluid.
  • Ask your doctor about when it is safe to shower, bathe, or soak in water.
  • Monitor your blood pressure regularly.
  • Increase your physical activity according to your doctor's instructions. This will help you avoid respiratory problems and improve the recovery of your digestive system.
  • Follow your doctor’s instructions.

Call Your Doctor    TOP

After you leave the hospital, contact your doctor if any of the following occurs:

  • Signs of infection, including fever and chills
  • Redness, swelling, increasing pain, excessive bleeding, or any discharge from the incision site
  • Nausea and/or vomiting
  • Pain that you cannot control with your medicine
  • Pain, burning, urgency, or frequency of urination; blood in the urine
  • Cough, shortness of breath, or chest pain
  • Pain and/or swelling in your feet, calves, or legs
  • Headaches
  • Lightheadedness
  • Any new symptom

In case of an emergency, call for medical help right away.

RESOURCES:

Urology Care Foundation
http://www.urologyhealth.org
National Institute of Diabetes and Digestive and Kidney Diseases
http://www.niddk.nih.gov

CANADIAN RESOURCES:

Canadian Urological Association
http://www.cua.org
The Kidney Foundation of Canada: British Columbia Branch
http://www.kidney.bc.ca

References:

Agha A, von Breitenbuch P, Gahli N, et al. Retroperitonenscopic adrenalectomy: lateral versus dorsal approach. J Surg Oncol . 2008;97:90-3.
Gallagher SF, Wahi M, Haines KL, et al. Trends in adrenalectomy rates, indications, and physician volume: A statewide analysis of 1816 adreanlectomies. Surgery . 2007;142:1011-21.
Hanssen WE, Kuhry E, Casseres YA. Safety and efficacy of endoscopic retroperitoneal adrenalectomy. Br J Surg . 2006;93:715-9.
Jossart GH, Burpee SE, Gagner M. Surgery of the adrenal glands. Endocrinol Metab Clin North Am . 2000;29:57-68.
Munver R, Del Pizzo JJ, Sosa RE. Adrenal-preserving minimally invasive surgery: the role of laparoscopic partial adrenalectomy, cryosurgery, and radiofrequency ablation of the adrenal gland. Curr Urol Rep . 2003;4:87-92.
Pamaby CN. The role of laparoscopic adrenalectomy for adrenal tumours of 6 cm or greater. Surg Endosc . 2008;22:617-21.
Thompson SK, Hayman AV, Ludlam WH, et al. Improved quality of life after bilateral laparoscopic adrenalectomy for Cushing’s disease: a 10-year experience. Ann Surg . 2007;245:790-94.
Last reviewed May 2013 by Kim Carmichael, MD; Michael Woods, MD
Last Updated: 5/28/2013