A laparoscopic adrenalectomy is a surgical procedure performed to remove one or both of the adrenal glands. The adrenal glands are located on top of each kidney and they produce a variety of hormones. Patients suffering from diseases of the adrenal glands or who have a tumor on either gland may need to have a laparoscopic adrenalectomy. The laparoscopic procedure is less invasive than open surgery and involves the use of a small camera and surgical instruments that are inserted into the abdomen.
Each adrenal gland is made up of two distinct regions. The outer cortex has a yellow color due to its high lipid content. This outer region produces hormones including aldosterone, which serves to regulate levels of sodium and potassium in the blood, and cortisol, which aids in regulation of glucose.
The inner region of the adrenal gland is known as the medulla. This region secretes two different hormones, epinephrine and norepinephrine, which are necessary to regulate blood pressure and heart rate. These hormones are involved in the stress response but are not necessary for life.
Diseases involving the adrenal glands may lead to an overproduction of adrenal hormones. Cushing’s syndrome is a disease that develops when the adrenal cortex produces too much cortisol. Pheochromocytoma is a tumor that can develop in the inner medulla. It leads to overproduction of epinephrine, and in such cases the afflicted person may experience high blood pressure, sweating, and an increased heart rate.
Diagnosis of adrenal disorders usually begins with blood tests that are done to determine hormone levels. If levels are high, the physician may order a magnetic resonance imaging (MRI) or computed tomography (CT) scan to detect tumors on either of the adrenal glands. If the physician determines that the adrenal glands need to be removed, the patient may need an adrenalectomy.
A laparoscopic adrenalectomy is usually performed if the patient has a tumor that is less than 2 inches (5 cm) on the adrenal gland. Tumors larger than 2.4 inches (6 cm) or those that may have spread into adjacent tissues are more commonly treated with an open adrenalectomy.
To begin, the physician inserts three or four trochars, or tubes, in the abdomen. These trochars are used to thread a camera and instruments into the abdomen. The physician then dissects the adrenal tissue while carefully cutting and clamping the central adrenal vein, which runs through the center of the gland. This procedure is less invasive than open surgery and recovery typically faster.
Patients undergoing a laparoscopic adrenalectomy should expect to spend a few days in the hospital. The procedure takes a few hours and is done while the patient is under general anesthesia. Patients should be walking within a day or two. After adrenalectomy, a person may need to take oral steroids to replenish those made by the adrenal glands.