Laparoscopic Adrenalectomy

Adrenal glands are two in number and are situated in the abdomen and lie just over each kidney. They produce chemicals that control several important processes in the body.

Tumours of the adrenal glands are very rare, and most are non-cancerous (benign) and are treated by an operation to remove the gland called ‘adrenalectomy’. This operation used to be carried out routinely through a long incision in the loin or abdomen (open operation), but is now performed in a considerable proportion of patients through a few small ‘keyhole’ incisions of 0.5-1.5 cm long (laparoscopic adrenalectomy).

Laparoscopic surgery is an ideal technique for removal of adrenal glands, as these glands are small structures and can be taken out through very small incisions. The benefits of this approach over open surgery include:

→ Less pain after surgery 
→ Shorter hospital stay (1-3 days, compared with 7-10 days following open surgery) 
→ Faster recovery and return to full activity and employment 
→ Less blood loss during surgery 
→ Better cosmetic result

This operation however is technically demanding and the surgeon should be skilled in advanced laparoscopic techniques.

→ Patients that have tumours of the adrenal glands producing excessive amounts of chemicals (hormones) with damaging effects on the body’s regulatory mechanisms. These tumours include:
  • Conn Syndrome
  • Pheochromocytoma
  • Cushing’s Syndrome or Cushing’s disease
  • Bilateral Adrenal Hyperplasia
→ Occasionally a CT-scan of the abdomen incidentally identifies a swelling (tumour) on one of the adrenal glands, and blood tests reveal no excessive production of chemicals. These tumours are called “incidentalinomas”, and do not require surgery unless they are large (4 cm or more), or are getting bigger on repeat scanning a few months later. 

→ Rarely, patients with lung, colon or other cancers may develop a single tumour spread to an adrenal gland. If the original lung, colon or other cancer could be treated, then it might be worthwhile considering removing the adrenal gland with the single tumour deposit.

No. Patients with adrenal carcinoma or adrenal masses greater than 10 cm in diameter are not suitable for laparoscopic adrenalectomy and should undergo open surgery.

Most patients tend to have a smooth recovery without any complications. However, just like any other surgery, complications may occur in a minority of patients and could include bleeding, infection, and bowel and blood pressure disturbances.

Conversion to an open operation may be needed if extreme difficulties were encountered during the laparoscopic surgery (1 in 20 patients), and may be associated with higher incidence of wound, chest and other complications. Thankfully, I have not needed to convert to an open operation to date and have done all adrenalectomies laparoscopically.