LAPAROSCOPIC ADRENALECTOMY

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The procedure of removal of an adrenal gland is called an adrenalectomy. There are two adrenal glands in the body on the right and left sides. The adrenal gland may be removed on one side or both sides at the time of surgery depending on the nature of disease.

Laparoscopic Adrenalectomy

Laparoscopic adrenalectomy is the procedure of choice for benign (non-cancerous) adrenal tumors. Laparoscopic surgery has proved to be a major advancement for the management of adrenal tumors. In this procedure three to five small incisions are made to insert a video chip camera and long tubes called ports through which long instruments are introduced for the surgery into the abdomen. 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. Patients that have undergone laparoscopic surgery have 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 after open surgery) and earlier return to work. The postoperative pain is markedly reduced after laparoscopic surgery and the general feeling of physical well being returns at a much faster rate.

At USC we offer specialized expertise in laparoscopic adrenalectomy. We perform the procedure utilizing both standard laparoscopic techniques and with a laparoscopic hand-access device.

Hand-assisted laparoscopic surgery (HALS)

Two new devices that allows the surgeon to insert a hand inside the abdomen during laparoscopic surgery have recently been developed. The procedure called hand-assisted laparoscopic surgery (HALS) allows better retraction and easier dissection of abdominal organs since the advantages of using the human hand that is present during open surgery is now also available during laparoscopic surgery.

We have pioneered HALS techniques for laparoscopic adrenalectomy and offer this procedure for large tumors in the adrenal gland that otherwise would require an open surgical procedure. We have found the use of the hand assist-device to be advantageous during laparoscopic surgery since the operative time is markedly reduced. Furthermore manipulation of the tumor with surgical instruments is reduced thus decreasing the risk of fracturing the tumor or having an incomplete excision of the tumor.

In larger tumors, standard laparoscopic procedures are less desirable, due to the risk of cancer. With hand-assisted laparoscopic surgery large adrenal tumors can be safely removed intact and with a rim of surrounding normal tissue to obtain clean microscopic-free margins around the tumor tissue. Furthermore the ability to intraoperatively palpate the tumor allows the surgeon to make an early assessment as to whether the lesion is benign (non-cancerous) or malignant (cancer) and therefore convert to an open procedure if cancer of the adrenal gland is suspected.

Common indications for laparoscopic removal of the adrenal gland are the following:

  • Benign adrenal tumors such as Cushing disease and Cohn syndrome
  • Pheochromocytoma
  • 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 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



Contact information: USC Center for Pancreatic and Biliary Diseases
1510 San Pablo Street, Los Angeles, CA
Phone:
1-855-724-7874 dde-mail:
PancreasDiseases@surgery.usc.edu
Programs: pancreatic cancer, pancreatitis, laparoscopic surgery, endocrine surgery,
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biliary surgery

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