Adrenal Surgery
The adrenal glands are triangular shaped glands that sit on top of the kidneys. They produce a number of hormones including cortisol, aldosterone, sex hormones and adrenaline.
Common Reasons for Considering Surgery on the Adrenal Glands
Overproduction of adrenal hormones In most cases only one hormone will be overproduced by the adrenal gland, usually due to a benign tumour. Symptoms relate to the specific hormone overproduced and may include changes to blood pressure, weight, heart rate, body potassium levels or appearance.
Enlarged adrenal gland The normal adrenal gland is between 1 and 3cm in size. A mass on the adrenal gland may be found on abdominal scans performed for other reasons. Even when this mass doesn't produce adrenal hormones, a large mass has an increased risk of adrenal cancer. While adrenal cancer is rare, the only curative treatment is surgery. Therefore, surgery may be considered for large or increasing adrenal masses.
What is involved with surgery on the Adrenal Glands?
Posterior Laparoscopic Adrenalectomy In most cases the adrenal gland can be removed via a laparoscopic (keyhole) operation from the back. This is performed under general anaesthetic with three small incisions beneath the rib cage on the back. This approach offers more direct access to the adrenal gland and shorter operative time. Most patients spend only 1-2 nights in hospital. This relatively new approach (within the last 5-10 years in Australia) is offered by Dr O'Neill as the only surgeon in the Hunter to provide this technique.
Laparoscopic Adrenalectomy When a posterior approach isn't feasible, patients may be suitable for anterior laparoscopic adrenalectomy. This operation involves 3-4 small incisions in the abdomen. Most patients stay in hospital 2-3 nights. Occasionally it's necessary to convert to open adrenalectomy.
Open Adrenalectomy For very large adrenal tumours (larger than 10cm) or where there's high cancer risk, open adrenalectomy is performed. This involves a surgical incision in the side below the ribs and longer hospital stay (five to seven days).
What are the risks of Adrenal Surgery?
The risks are small, however any operation has risks:
Bleeding The adrenal gland is highly vascular and runs adjacent to very large vessels. Great care is taken to minimise bleeding risk, though significant bleeding rarely occurs. In these rare instances, blood transfusion may be required.
Complications Related to Adrenal Hormones Where the adrenal gland is overactive, medication may be necessary to control hormones prior to surgery. Certain adrenal tumours can cause very high blood pressure, requiring intensive monitoring in the intensive care unit after surgery. Blood pressure can be controlled with medication and usually only short-term intensive monitoring is needed. Dr O'Neill will discuss this with you if applicable.
After removal of one adrenal gland, the remaining gland almost always produces sufficient hormones. Where the adrenal gland was overproducing cortisol, steroid tablets are usually required after surgery, though most patients can be weaned off these over the following months.
Any operation with general anaesthetic carries risks including heart problems, lung problems, blood clots, and drug reactions, though serious complications in healthy patients are extremely rare.
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