Adrenalectomy



The adrenal glands, which include the adrenal cortex and medulla, are located on top of the kidneys. The adrenal cortex is the outer and bigger part of the adrenal gland. It produces hormones, including glucocorticoids (cortisol) and mineralocorticoids (aldosterone), which control the body’s metabolic process. Without cortisol or aldosterone the body is not able to respond adequately under minimal physical or emotional stress, including change in temperature, exercise, or excitement.

The adrenal medulla, the inner portion of the adrenal gland, secretes the stimulants epinephrine and norepinephrine. Pheochromocytoma, a tumor of the adrenal medulla, causes excessive amounts of these stimulants to be released, resulting in hypertension. Pheochromocytoma is most common in young people. Only a small percentage of the lesions is malignant.

When an adrenal tumor or malignancy is present, an adrenalectomy (removal of one or both adrenal glands) is performed to reduce excessive secretions of adrenal hormones. If surgery is the form of treatment your doctor recommends, physicians at the Cleveland Clinic who specialize in this procedure can determine if laparoscopic adrenalectomy is appropriate for you.

How is laparoscopic adrenalectomy performed?
An adrenalectomy is the removal of one adrenal gland (unilateral adrenalectomy), the removal of both adrenal glands (bilateral adrenalectomy), or partial removal of one or both adrenal glands. Laparoscopic adrenalectomy uses a thin, telescope-like instrument called a laparoscope, which is inserted through a small incision in the flank (fleshy area between the ribs and hip). The laparoscope is connected to a tiny video camera – smaller than a dime – which projects a view of the operative site onto video monitors located in the operating room. The abdomen is inflated with carbon dioxide, a gas, to allow your surgeon a better view of the operative area. Two or three additional small incisions are made near the laparoscope through which the surgeon inserts specialized surgical instruments. The surgeon manipulates these instruments to perform the adrenalectomy. Following the procedure, the small incisions are closed with sutures and covered with surgical tape. After a few months, they are barely visible.

What are the benefits of laparoscopic adrenalectomy?
• Three or four tiny scars instead of one large abdominal scar
• Less risk of hernia development
• Less chronic pain resulting from nerve damage
• Reduced postoperative pain
• Shorter hospital stay – you may leave one or two days after surgery
• Shorter recovery time – days instead of weeks – and quicker return to daily activities, including work

What can I expect after surgery?
It is important to follow your doctor’s instructions after surgery. Although many people feel better in just a few days, you may need to take it easy for two to four weeks.

How safe is laparoscopic adrenalectomy?
If performed by experts in this field, laparoscopic adrenalectomy is as safe as “open” surgery in carefully selected cases.

Appointment
To schedule an appointment, please call the Department of General Surgery at 216-444-6664.