Laparoscopic Adrenalectomy

The adrenal glands are organs a few centimetres in size located above each kidney. They produce hormones such as cortisol, aldosterone and adrenaline, which regulate the body’s blood pressure, blood sugar and response to stress.

Laparoscopic adrenalectomy is the removal of one of these glands (rarely both) through a few small incisions in the abdomen, with the help of a camera. It is commonly known as “keyhole surgery”. Because no large incision is made, it generally means less pain, a shorter hospital stay and faster recovery than open surgery.

Not every mass in the adrenal gland requires an operation; many small masses that do not produce hormones are only monitored. Surgery is generally considered in the following situations:

• Hormone-producing (hormonally active) masses: masses producing excess cortisol (Cushing’s syndrome), masses producing excess aldosterone (Conn’s syndrome; this can lead to high blood pressure and low potassium) and the adrenaline-producing phaeochromocytoma.
• Masses above a certain size or growing during monitoring
• Masses suspected of being malignant (cancer) on imaging: in this case, depending on the features of the mass, the open method may be preferred instead of keyhole surgery.

For hormonally active masses, the decision to operate and the preparation are carried out jointly with the endocrinology (hormone diseases) department. Particularly with phaeochromocytoma, preparation before the operation with medicines that regulate blood pressure is important for the safety of the operation. In Cushing’s or Conn’s syndrome, too, hormone levels, blood pressure and potassium values are regulated before the operation. You can ask your doctor about the details of this preparation process.

The operation is performed under general anaesthesia (you are fully asleep). Usually 3-4 incisions of about 0.5-1 centimetre are made in the abdomen. The abdomen is inflated with carbon dioxide gas to create a working space.

A thin tube with a camera, called a laparoscope, is passed through one of the incisions, and surgical instruments through the others. The adrenal gland is carefully separated from the surrounding tissues and its blood vessels and freed, then removed in a protective bag by slightly enlarging one of the incisions. The operation mostly takes 1-3 hours.

Depending on the location of the mass, an approach from the front of the abdomen (transperitoneal) or from the back and side (retroperitoneal) may be chosen. Rarely, it may be necessary to switch to the open method during the operation for reasons such as bleeding or difficulty with visibility; this is not a failure but a decision taken for safety.

As with any operation, laparoscopic adrenalectomy carries some risks. These may vary from patient to patient and according to the type and size of the mass:

• Bleeding and the need for a blood transfusion
• Wound infection or infection inside the abdomen
• Injury to neighbouring organs (spleen, liver, pancreas, kidney and major blood vessels)
• Switching to the open method during the operation
• Hormone fluctuations: particularly with phaeochromocytoma, rises and falls in blood pressure may occur during the operation
• Risks related to anaesthesia and blood clot formation in the leg veins (thrombosis)

With cortisol-producing masses, hormone production by the remaining gland may be insufficient for a time; temporary cortisol support may be needed during this period. This follow-up is planned together with endocrinology. It is important to talk to your doctor for a risk assessment specific to you.

Patients usually get up a few hours after the operation and start eating and drinking on the same day or the following day. The hospital stay is mostly 1-3 days; with hormonally active masses this may be longer depending on the need for monitoring.

After discharge, mild pain, tenderness at the incision sites and gas pain radiating to the shoulders may last a few days. Because the incisions are small, the scars fade noticeably over time.

The removed tissue is sent for pathology examination; the result is usually available within 1-2 weeks and the follow-up plan is shaped accordingly. In patients operated on for a hormonally active mass, blood pressure, blood sugar and hormone levels are checked at regular intervals by endocrinology. If fever, increasing abdominal pain, redness or discharge at an incision site, or marked weakness occurs, contact your doctor without delay.