Laparoscopic Adrenalectomy
WHEN IS ADRENAL SURGERY NEEDED?
An adrenalectomy (the surgical removal of the adrenal gland) may be required in cases of hormone overproduction or if there is a concern that a mass of the adrenal gland may be a cancer. The four scenarios where hormone excess requires adrenalectomy are Cushing's Syndrome, Conn's Syndrome, phaeochromocytomas and less commonly due to sexual hormone excess.
Adrenal tumours that are non functioning can be encountered during other radiological tests on the abdomen. Adrenalectomy may be required in such cases because the risk of cancer increases as the size of the gland increases or because there are other concerning features on the scans of the mass.
HOW IS ADRENAL SURGERY USUALLY PERFORMED?
Adrenalectomy may be performed as an open procedure or a minimally invasive (key hole) procedure. Open operations may be performed through the back (sometimes requiring partial removal of a rib), the flank, or the front of the abdomen. Minimally invasive procedures as their name suggests require much smaller incisions either from the front/side in the case of laparoscopic adrenalectomy or via the back in the newer technique of retroperitoneoscopic adrenalectomy.
The method of adrenalectomy adopted is highly patient specific and will depend on the disease being treated, tumour size, and general patient health but overall with the exception of definite cancer the retroperitoneoscopic or laparoscopic approaches are preferred.
LAPAROSCOPIC ADRENALECTOMY
The first pioneering laparoscopic adrenalectomy was performed in the 1992 and following refinement of the technique this replaced open surgery for removing benign adrenal tumours. Laparoscopic adrenal surgery has numerous advantages over the older open technique including smaller incisions and therefore less stress for the patient, less post-operative pain, and therefore earlier mobility after the operation and as a result fewer chest and clot related complications. The operation involves the use of 3 or 4 small cuts through which a telescope and specialised instruments are passed which allow the operation to be performed with the benefit of magnification on a TV screen.
RETROPERITONEOSCOPIC ADRENALECTOMY
This is a newer technique best described and perfected by Prof Martin Walz. The operation is performed by the insertion of a small camera and 2 small ports for special instruments as in the laparoscopic approach. The operation is associated with less pain and data from Hammersmith Hospital shows a statistically significant shorter stay with nearly all patients discharged on the day following surgery.