What is an adrenalectomy?

Adrenalectomy is a surgical procedure to remove one or both adrenal glands. Adrenalectomy can be performed as an open surgery; however, expert surgeons at Cleveland Clinic prefer to perform laproscopic adrenalectomy. Instead of performing the surgery through one large incision, the surgeons use three or four smaller incisions that heal quickly and leave less scar tissue behind.

What are the adrenal glands?

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 these adrenal lesions are malignant.

Why would someone need an adrenalectomy?

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 adrenal surgery is the form of treatment your doctor recommends, physicians at Cleveland Clinic who specialize in adrenal surgery can determine if laparoscopic adrenalectomy is the appropriate surgery for you.

What happens before an adrenalectomy?

Depending on the underlying condition that is causing adrenal problems (Cushing's syndrome, pheochromocytoma) there are steps that will be taken by your doctor to help normalize your symptoms to reduce complication risk in surgery. For example, if you have a pheochromocytoma, you'll be given medications to control high blood pressure and heart rate. Patents with Cushing's syndrome will receive cortisone medication.

Additionally, as with many surgeries, you'll be asked to abstain from NSAIDs or other blood thinning medications to reduce risk of bleeding during surgery. Your doctors will ask you to quit smoking as it will adversely affect healing after your surgery.

Midnight before your surgery, you should not eat or drink anything. If you are given medications to take the day of the surgery, you should take them only with a small sip of water.

What happens during a laproscopic adrenalectomy?

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 adrenal surgery?

  • 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 adrenal surgery
  • Shorter recovery time – days instead of weeks – and quicker return to daily activities, including work

What happens after laproscopic adrenalectomy?

Although many people feel relief from high blood pressure or other symptoms in just a few days, you will likely need to abstain from very strenuous activities for two to four weeks.

How safe is laparoscopic adrenalectomy surgery?

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