ADRENALECTOMy

The procedure of removal of an adrenal gland is called an adrenalectomy. There are two adrenal glands in the body, both the right and left adrenal glands are located just above and to the right of the kidney. One or both adrenal glands may be removed by surgery depending on the nature of disease. Common reasons for removal of the adrenal gland include the following:

• Benign adrenal tumors such as Cushing disease and Conn's syndrome
• Pheochromocytoma
• Adrenal cancer
• Metastatic disease (spread) from lung, breast and other cancers. This is an uncommon reason for removal of the adrenal gland. The adrenal gland would only be considered for removal in metastatic disease if this were the only site of metastatic disease
• Adrenal mass (enlargement) of uncertain origin If a mass in the adrenal gland is more than 4cm large then there is a higher risk of cancer than a smaller mass. Given the safety record of a laparoscopic adrenalectomy and the risk of cancer in an adrenal gland that is abnormally enlarged more that 4cm, removal of the gland should be considered
• Cushing's syndrome Removal of both adrenal glands is sometimes considered in patients who have brain pituitary tumors that produce excessive amounts of a hormone called ACTH. ACTH stimulates the adrenal to release steroids. In patients with pituitary tumors producing excessive amounts of ACTH, the adrenal is stimulated to produce an excessive amount of steroids causing a Cushing syndrome. If the pituitary tumor is not treatable by standard neurosurgical and radiation treatments, then both the adrenal glands are removed to treat Cushing syndrome

Surgical techniques for removal of the adrenal gland

Open Surgery

Traditionally the adrenal gland has been removed through open surgery and different surgical approaches have been utilized. Two common approaches have been to go through the abdomen or to go through the back. Open surgery to remove the adrenal gland is associated with a large incision that is often painful and is associated with a prolonged recovery period. Today the only indication for open surgery would be in patients with cancer of the adrenal glands or patients that have an abnormal and a very large adrenal gland that is greater than 10cm (6”). For all other patients a laparoscopic adrenalectomy is preferred.

Laparoscopic Adrenalectomy

Laparoscopic adrenalectomy is the procedure of choice for benign (non-cancerous) adrenal tumors. In this procedure three to five small incisions are made and a video camera and long tubes called ports through which long instruments are introduced into the abdomen for the surgery are utilized. The video chip camera projects an image of the inside of the abdomen on a television monitor and the surgeon then performs the surgery while visualizing the procedure on the TV monitor.

A variation of laparoscopic procedure is performed utilizing new hand-access devices called the gelport or lap disc that are inserted into the abdomen through a 2” incision and allows the surgeon to introduce a hand inside the abdomen during the laparoscopic procedure. Hand-assisted laparoscopic surgery allows better retraction and easier dissection of intrabdominal organs since the advantages of using the human hand that is present during open surgery is now also available during laparoscopic surgery.

In almost all studies reported to date, patients that have undergone laparoscopic surgery have had much shorter hospitalization (the average hospitalization after a laparoscopic procedure is one to two days compared to five to seven days after an open procedure), more rapid recovery (approximately 2 weeks compared to 4 to 8 weeks in open surgery) and earlier return to work. The postoperative pain is markedly reduced after laparoscopic surgery and the general physical well being returns at a much faster rate.

Laparoscopic adrenalectomy has proved to be a major advance in the management of adrenal tumors.

At USC we offer specialized expertise for this procedure. We have pioneered the laparoscopic procedure utilizing a hand-access device and offer this procedure for larger tumors in the adrenal gland that otherwise would require an open surgical procedure.

Contact information: USC Center for Pancreatic and Biliary Diseases
1510 San Pablo Street, Los Angeles, CA
Phone: 323-4425837 dde-mail:PancreasDiseases@surgery.usc.edu
Programs: pancreatic cancer, pancreatitis, laparoscopic surgery, endocrine surgery,
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