Adrenalectomy
Adrenalectomy is a surgical procedure aimed at removing one or both adrenal glands, which are responsible for producing hormones that regulate various bodily functions, including the stress response. This surgery is often indicated when the adrenal glands are diseased, such as in cases of cancer, or when hormonal imbalances exacerbate other health conditions. Common symptoms prompting this surgery may include anxiety, high blood pressure, obesity, and fatigue.
There are two main techniques for performing an adrenalectomy: laparoscopic surgery and open surgery. Laparoscopic adrenalectomy is less invasive and involves making small incisions, suitable for tumors less than ten centimeters that are not malignant. In contrast, open adrenalectomy is used for larger or cancerous tumors and requires a larger incision, allowing for a thorough exploration of the abdominal cavity.
While the recovery time for laparoscopic procedures is shorter, with hospitalization lasting two to three days, open surgeries typically require four to five days. Both procedures carry risks, such as infection and bleeding, but these risks are generally outweighed by the benefits of tumor removal. Post-surgery, patients may need hormone replacement therapy to compensate for the loss of adrenal function.
Subject Terms
Adrenalectomy
Anatomy or system affected: Abdomen, endocrine system, glands, kidneys, urinary system
Definition: The surgical removal of one or both of the adrenal glands
Indications and Procedures
The adrenal glands produce chemical substances which regulate the body’s responses to stress, including the fight-or-flight response. Occasionally, if the adrenal glands become diseased (for example, with cancer) or the hormones that they produce aggravate another condition (such as breast cancer), a physician may determine that they must be surgically removed. Symptoms a patient may suffer from adrenal issues include anxiety, high blood pressure, obesity, headaches, fatigue, and frequent urination. Benign tumors of the adrenal gland may sometimes produce additional hormones that disrupt body functions. The tumors, and possibly the adrenal glands, must be removed to rectify the condition.
Depending on the type of tumor, adrenalectomy may require major surgery or less invasive laparoscopic surgery. Candidates for laparoscopic surgery include patients whose tumors are less than ten centimeters in diameter and have no malignant characteristics. In the laparoscopic procedure, the surgeon makes three to four small incisions, then inserts small telescopes on long instruments into the abdominal cavity. The abdomen is inflated with gas, and a camera on an instrument displays images on a monitor. The surgeon uses these images to navigate to the tumor and, with fine instruments, ties off blood vessels and disconnects the adrenal gland. The gland is placed into a small plastic bag inserted into the abdomen and then removed through the incision.
An open adrenalectomy is performed on large or cancerous tumors. It requires a large incision under the rib cage along the middle of the abdomen or along the side of the body. This more invasive procedure allows the surgeon to explore the organs of the abdominal cavity for disease. The colon and a portion of the small intestine are moved to expose the kidneys. After the adrenal veins and arteries are sealed, each gland is dissected from its position at the top of each kidney. Internal organs are replaced, drains are brought out through the incisions, and the incisions are closed. The procedure may also be performed by a posterior approach through the rib cage.
Uses and Complications
Open adrenalectomies require four to five days of hospitalization, whereas laparoscopic procedures require two to three days. Complications of abdominal surgery are possible, including infection and internal bleeding, as are other potential complications of major surgery, including negative reaction to anesthesia. The risks of the surgery are small in comparison to the risk of not removing the adrenal tumor. The patient is monitored closely post-surgery and given synthetic replacements for the hormones normally provided by the adrenal glands.
Bibliography
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"Adrenalectomy—Laparoscopic Surgery." Health Library, May 28, 2013.
"Adrenalectomy—Open Surgery." Health Library, May 28, 2013.
Beldegrum, Arie, et al., eds. Renal and Adrenal Tumors. New York: Oxford University Press, 2002.
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