adrenalectomy
carey lc, ellison eh. adrenalectomy: technique, errors, and pitfalls .
adrenalectomy is a surgery that involves removing either one or both the adrenal glands .
the transperitoneal approach more closely mirrors the open approach to adrenalectomy and is the approach used at our institution. accordingly, this topic concentrates on transperitoneal laparoscopic left adrenalectomy .
experience of the surgeon surgeons without training in laparoscopic surgery should not perform laparoscopic adrenalectomy .
laparoscopic right adrenalectomy: adrenal gland removal. video courtesy of william w hope, md .
laparoscopic right adrenalectomy: liver retraction and dissection. video courtesy of william w hope, md .
history of prior abdominal surgery in this scenario, laparoscopic adrenalectomy may still be possible. significant scar tissue from another surgery may limit the success of the laparoscopic technique and open adrenalectomy may be needed .
mohler jl, flueck ja, mcroberts jw. adrenal insufficiency following unilateral adrenalectomy: a case report .
type of anesthesia: adrenalectomy is done under general anesthesia. you will fall asleep during the procedure .
in patients with adrenalectomy due to malignant indications require regular follow - up to check for the recurrence .
the indications for laparoscopic adrenalectomy have evolved since its initial description and subsequent wide adoption. current indications are the same for laparoscopic adrenalectomy as for open surgery, except in cases of suspected or confirmed adrenocortical carcinoma .
your doctor can explain your treatment options and discuss whether an adrenalectomy is the most appropriate treatment for you .
with adrenalectomy alone, roughly 35% of patients with hyperaldosteronism no longer require medications for hypertension. [ 14 ]
if performed by experts in this field, laparoscopic adrenalectomy is as safe as “open” surgery in carefully selected cases .
egdahl rh, melby jc. recurrent cushing' s disease and intermittent functional adrenal cortical insufficiency following subtotal adrenalectomy .
initially, open adrenalectomy was preferred in cases of suspected adrenocortical carcinoma. today, however, there are few absolute contraindications for laparoscopic adrenalectomy. laparoscopic approaches to the treatment of all adrenal pathologies have been successfully performed. [ 4, 15, 16, 17 ] as experience with laparoscopic adrenalectomy has increased, the absolute contraindications have dwindled .
winfield hn, hamilton bd, bravo el, novick ac. laparoscopic adrenalectomy: the preferred choice? a comparison to open adrenalectomy. j urol. 1998 aug. 160 (2): 325 - 9. [ medline ] .
nelson dh, meakin jw, thorn gw. acth - producing pituitary tumors following adrenalectomy for cushing' s syndrome .
brunicardi fc, rosman pm, lesser kl, andersen dk. current status of adrenalectomy for cushing' s disease .
nwariaku f. adrenalectomy: minimally invasive surgery (mis) and traditional open procedures. urltoken accessed july 9, 2017 .
most patients take 1 to 2 weeks to recover from the laparascopic surgery and 5 to 6 weeks from an open adrenalectomy .
russell cf, hamberger b, van heerden ja, edis aj, ilstrup dm. adrenalectomy: anterior or posterior approach ?
barbara woodward lips patient education center. adrenalectomy. rochester, minn. : mayo foundation for medical education and research. 2017 .
outcomes of adrenalectomy for adrenocortical carcinoma are generally poor because this disease tends to present at an advanced stage. a large retrospective review from md anderson cancer center reported an overall survival of around 58% , with 86% of these cases undergoing adrenalectomy. [ 15 ]
brunt lm, doherty gm, norton ja, soper nj, quasebarth ma, moley jf. laparoscopic adrenalectomy compared to open adrenalectomy for benign adrenal neoplasms. j am coll surg. 1996 jul. 183 (1): 1 - 10. [ medline ] .
laparoscopic transabdominal left adrenalectomy. procedure performed by james lee, md, columbiadoctors, new york, ny. video courtesy of columbiadoctors. urltoken
laparoscopic adrenal gland removal (adrenalectomy) patient information from sages. society of american gastrointestinal and endoscopic surgeons. urltoken accessed aug. 21, 2017 .
economopoulos kp, et al. laparoscopic versus robotic adrenalectomy: a comprehensive meta - analysis. international journal of surgery. 2017; 38: 95 .
wu s, lai h, zhao j, chen j, mo x, zuo h, et al. laparoendoscopic single - site adrenalectomy versus conventional laparoscopic adrenalectomy: an updated meta analysis. urol j. 2016 apr 16. 13 (2): 2590 - 8. [ medline ] .
type of tumor (benign versus cancer) when cancer of the adrenal gland is found, the technique of choice for removing the cancer is open adrenalectomy .
assalia a, gagner m. laparoscopic adrenalectomy. br j surg. 2004 oct. 91 (10): 1259 - 74. [ medline ] .
chai yj, woo jw, kwon h, choi jy, kim sj, lee ke. comparative outcomes of lateral transperitoneal adrenalectomy versus posterior retroperitoneoscopic adrenalectomy in consecutive patients: a single surgeon' s experience. asian j surg. 2016 apr. 39 (2): 74 - 80. [ medline ] .
bruining ha, lamberts sw, ong eg, van seyen aj. results of adrenalectomy with various surgical approaches in the treatment of different diseases of the adrenal glands .
wang ds, terashi t. laparoscopic adrenalectomy. urol clin north am. 2008 aug. 35 (3): 351 - 63, vii. [ medline ] .
gumbs aa, gagner m. laparoscopic adrenalectomy. best pract res clin endocrinol metab. 2006 sep. 20 (3): 483 - 99. [ medline ] .
indications for adrenalectomy may seem straightforward at first. however, with the increasing rates of diagnosis of asymptomatic and likely benign adrenal masses, management still remains controversial. [ 10 ]
in cases of widely metastatic disease with a concomitant adrenal mass, tissue diagnosis should be obtained before the decision is made to proceed with adrenalectomy because primary adrenal carcinoma is rare .
cohen kl, noth rh, pechinski t. incidence of pituitary tumors following adrenalectomy. a long - term follow - up study of patients treated for cushing' s disease .
sho s, yeh mw, li n, livhits mj. single - incision retroperitoneoscopic adrenalectomy: a north american experience. surg endosc. 2016 nov 8. [ medline ] .
laparoscopic adrenalectomy (la) is the procedure of choice for surgical management of the adrenal masses. our objective is to show a standardized assessment of perioperative complications in one la series .
although laparoscopic surgery has become the treatment of choice for the majority of incidentally detected adrenal masses, open adrenalectomy still plays an important role in the armamentarium of adrenal surgeons. [ 1 ]
after an adrenal lesion is identified, it is imperative to determine the specific diagnosis. this is critical, in that the indications for adrenalectomy are twofold: tumor functionality and malignant potential .
strebel rt, müntener m, sulser t. intraoperative complications of laparoscopic adrenalectomy. world j urol. 2008 dec. 26 (6): 555 - 60. [ medline ] .
li qy, li f. laparoscopic adrenalectomy in pheochromocytoma: retroperitoneal approach versus transperitoneal approach. j endourol. 2010 sep. 24 (9): 1441 - 5. [ medline ] .
an alternative approach to laparoscopic surgery is a posterior retroperitoneoscopic adrenalectomy (pra), in which surgeons make small incisions in your back. sometimes surgeons use the robotic da vinci surgical system to perform laparoscopic adrenalectomies .
conzo g, et al. minimally invasive approach for adrenal lesions: systematic review of laparoscopic versus retroperitoneoscopic adrenalectomy and assessment of risk factors for complications. international journal of surgery. 2016; 28: s118 .
typically, nonfunctioning tumors smaller than 4 cm can be monitored with serial imaging; these are unlikely to be malignant. patients with nonfunctioning tumors 4 - 6 cm in size should be presented with the options of serial imaging or laparoscopic adrenalectomy. the decision regarding treatment should be individualized. patients with a solitary adrenal metastasis and no evidence of other metastatic disease are also candidates for laparoscopic adrenalectomy. [ 23, 24 ]
gagner m, lacroix a, bolté e. laparoscopic adrenalectomy in cushing' s syndrome and pheochromocytoma. n engl j med. 1992 oct 1. 327 (14): 1033. [ medline ] .
macgillivray dc, shichman sj, ferrer fa, malchoff cd. a comparison of open vs laparoscopic adrenalectomy. surg endosc. 1996 oct. 10 (10): 987 - 90. [ medline ] .
mohammad wm, frost i, moonje v. outpatient laparoscopic adrenalectomy: a canadian experience. surg laparosc endosc percutan tech. 2009 aug. 19 (4): 336 - 7. [ medline ] .
gagner m, lacroix a, bolte e. laparoscopic adrenalectomy in cushing' s syndrome and pheochromocytoma. n engl j med. 1992 oct 1. 327 (14): 1033. [ medline ] .
agha a, von breitenbuch p, gahli n, piso p, schlitt hj. retroperitonenscopic adrenalectomy: lateral versus dorsal approach. j surg oncol. 2008; 97 (1): 90 - 93 .
a retrospective study of 201 patients who underwent either minimally invasive or open surgical adrenalectomy for adrenocortical carcinoma at 13 tertiary care cancer centers found that the minimally invasive approach was an acceptable alternative for tumors no larger than 10 cm. [ 21 ] however, the authors recommended that open adrenalectomy be performed in cases where there is preoperative or intraoperative evidence of local invasion or where enlarged lymph nodes are noted, regardless of size .
surgeons may perform an adrenalectomy through minimally invasive (laparoscopic) or traditional open surgery, or use cryoablation. the procedure they recommend depends on the size and type of tumor or the condition affecting your adrenal gland .
surgit o. clipless and sutureless laparoscopic adrenalectomy carried out with the ligasure device in 32 patients. surg laparosc endosc percutan tech. 2010 apr. 20 (2): 109 - 13. [ medline ] .
murphy mm, witkowski er, ng sc, et al. trends in adrenalectomy: a recent national review. surg endosc. 2010 oct. 24 (10): 2518 - 26. [ medline ] .
nau p, demyttenaere s, muscarella p, et al. pheochromocytoma does not increase risk in laparoscopic adrenalectomy. surg endosc. 2010 nov. 24 (11): 2760 - 4. [ medline ] .
bulus h, uslu hy, karakoyun r, koçak s. comparison of laparoscopic and open adrenalectomy. acta chir belg. 2013 may - jun. 113 (3): 203 - 7. [ medline ] .
bergamini c, martellucci j, tozzi f, valeri a. complications in laparoscopic adrenalectomy: the value of experience. surg endosc. 2011 dec. 25 (12): 3845 - 51. [ medline ] .
naya y, nagata m, ichikawa t, et al. laparoscopic adrenalectomy: comparison of transperitoneal and retroperitoneal approaches. bju int. 2002 aug. 90 (3): 199 - 204. [ medline ] .
sartori pv, romano f, uggeri f, et al. energy - based hemostatic devices in laparoscopic adrenalectomy. langenbecks arch surg. 2010 feb. 395 (2): 111 - 4. [ medline ] .
after laparoscopic adrenalectomy, patients may be discharged from the hospital as early as the day after surgery. patients with cushing' s syndrome may be asked to stay for 2 to 3 days to begin their steroid taper (i. e. slowly lowering the amount of steroid pills they are taking). on the other hand, after open adrenalectomy, patients stay 3 to 5 days on average, mainly to help control post - operative discomfort .
boylu u, oommen m, lee br, thomas r. laparoscopic adrenalectomy for large adrenal masses: pushing the envelope. j endourol. 2009 jun. 23 (6): 971 - 5. [ medline ] .
hanssen we, kuhry e, casseres ya, de herder ww, steyerberg ew, bonjer hj. safety and efficacy of endoscopic retroperitoneal adrenalectomy. br j surg. 2006; 93 (6): 715 - 719 .
bolli m, oertli d, staub jj, harder f. laparoscopic adrenalectomy: the new standard? . swiss med wkly. 2002 jan 12. 132 (1 - 2): 12 - 6. [ medline ] .
lee gs, arghami a, dy bm, mckenzie tj, thompson gb, richards ml. robotic single - site adrenalectomy. surg endosc. 2016 aug. 30 (8): 3351 - 6. [ medline ] .
gupta pk, natarajan b, pallati pk, gupta h, sainath j, fitzgibbons rj jr. outcomes after laparoscopic adrenalectomy. surg endosc. 2011 mar. 25 (3): 784 - 94. [ medline ] .
open surgery: in open surgery, the skin incision is single and large. it is mainly required for large tumors, in patients with history of abdominal surgery with adhesions and if the adrenal gland is invisible during laparoscopic adrenalectomy .
schell sr, talamini ma, udelsman r. laparoscopic adrenalectomy for nonmalignant disease: improved safety, morbidity, and cost - effectiveness. surg endosc. 1999 jan. 13 (1): 30 - 4. [ medline ] .
rubinstein m, gill is, aron m, et al. prospective, randomized comparison of transperitoneal versus retroperitoneal laparoscopic adrenalectomy. j urol. 2005 aug. 174 (2): 442 - 5; discussion 445. [ medline ] .
gallagher sf, wahi m, haines kl, et al. trends in adrenalectomy rates, indications, and physician volume: a statewide analysis of 1, 816 adreanlectomies. surgery. 2007; 142 (6): 1011 - 1021 .
in addition, open adrenalectomy is the treatment of choice for patients in whom laparoscopic surgery is contraindicated. a patient' s inability to undergo pneumoperitoneum is an absolute contraindication for laparoscopy. multiple previous abdominal operations and obesity remain relative contraindications for laparoscopy .
the outcomes of open adrenalectomy vary with the pathology of the disease process, and morbidity changes according to the approach chosen. approaches that limit access to the peritoneum greatly decrease the rates of postoperative ileus; however, vascular control is often difficult .
hazzan d, shiloni e, golijanin d, jurim o, gross d, reissman p. laparoscopic vs open adrenalectomy for benign adrenal neoplasm. surg endosc. 2001 nov. 15 (11): 1356 - 8. [ medline ] .
rieder jm, nisbet aa, wuerstle mc, tran vq, kwon eo, chien gw. differences in left and right laparoscopic adrenalectomy. jsls. 2010 jul - sep. 14 (3): 369 - 73. [ medline ] .
henry jf, defechereux t, raffaelli m, lubrano d, gramatica l. complications of laparoscopic adrenalectomy: results of 169 consecutive procedures. world j surg. 2000 nov. 24 (11): 1342 - 6. [ medline ] .
brix d, allolio b, fenske w, et al. laparoscopic versus open adrenalectomy for adrenocortical carcinoma: surgical and oncologic outcome in 152 patients. eur urol. 2010 oct. 58 (4): 609 - 15. [ medline ] .
gill is, meraney am, thomas jc, sung gt, novick ac, lieberman i. thoracoscopic transdiaphragmatic adrenalectomy: the initial experience. j urol. 2001 jun. 165 (6 pt 1): 1875 - 81. [ medline ] .
yoshimura k, yoshioka t, miyake o, matsumiya k, miki t, okuyama a. comparison of clinical outcomes of laparoscopic and conventional open adrenalectomy. j endourol. 1998 dec. 12 (6): 555 - 9. [ medline ] .
vargas hi, kavoussi lr, bartlett dl, wagner jr, venzon dj, fraker dl, et al. laparoscopic adrenalectomy: a new standard of care. urology. 1997 may. 49 (5): 673 - 8. [ medline ] .
boris rs, gupta g, linehan wm, pinto pa, bratslavsky g. robot - assisted laparoscopic partial adrenalectomy: initial experience. urology. 2011 apr. 77 (4): 775 - 80. [ medline ]. [ full text ] .
perretta s, allemann p, asakuma m, dallemagne b, marescaux j. adrenalectomy using natural orifice translumenal endoscopic surgery (notes): a transvaginal retroperitoneal approach. surg endosc. 2009 jun. 23 (6): 1390. [ medline ] .
pamaby cn, chong ps, chisholm l, farrow j, connell jm, o' dwyer pj. the role of laparoscopic adrenalectomy for adrenal tumours of 6 cm or greater. surg endosc. 2008; 22 (3): 617 - 621 .
gagner m, lacroix a, prinz ra, bolte e, albala d, potvin c. early experience with laparoscopic approach for adrenalectomy. surgery. 1993 dec. 114 (6): 1120 - 4; discussion 1124 - 5. [ medline ] .
miccoli p, raffaelli m, berti p, materazzi g, massi m, bernini g. adrenal surgery before and after the introduction of laparoscopic adrenalectomy. br j surg. 2002 jun. 89 (6): 779 - 82. [ medline ] .
cindolo l, gidaro s, neri f, tamburro fr, schips l. assessing feasibility and safety of laparoendoscopic single - site surgery adrenalectomy: initial experience. j endourol. 2010 jun. 24 (6): 977 - 80. [ medline ] .
most of the aforementioned approaches to adrenalectomy are in their infancy, with only the initial experiences of select surgeons documented. the two most commonly used approaches remain transperitoneal and retroperitoneal laparoscopic adrenalectomy, each of which has its own inherent benefits and shortcomings. some authors have found the retroperitoneal approach to be faster and associated with lower blood loss in the setting of pheochromocytoma. [ 32 ] others have attempted to exclude adrenal pathology as a confounding factor and have found transperitoneal to be faster with a shorter learning curve. [ 33 ]
munver r, del pizzo jj, sosa re. adrenal - preserving minimally invasive surgery: the role of laparoscopic partial adrenalectomy, cryosurgery, and radiofrequency ablation of the adrenal gland. curr urol rep. 2003; 4 (1): 87 - 92 .
adrenalectomy is the removal of one or both adrenal glands. there is one adrenal gland on top of each kidney. the adrenal glands make several hormones, including cortisol, aldosterone, and sex steroids. the adrenal glands also make adrenaline and noradrenaline in small amounts .
thompson sk, hayman av, ludlam wh, deveney cw, loriaux dl, sheppard bc. improved quality of life after bilateral laparoscopic adrenalectomy for cushing’s disease: a 10 - year experience. ann surg. 2007; 245 (5): 790 - 794 .
ortega j, sala c, garcia s, lledo s. cost - effectiveness of laparoscopic vs open adrenalectomy: small savings in an expensive process. j laparoendosc adv surg tech a. 2002 feb. 12 (1): 1 - 5. [ medline ] .
rieder jm, nisbet aa, wuerstle mc, tran vq, kwon eo, chien gw. differences in left and right laparoscopic adrenalectomy. jsls. 2010 jul - sep. 14 (3): 369 - 73. [ medline ]. [ full text ] .
berber e, tellioglu g, harvey a, mitchell j, milas m, siperstein a. comparison of laparoscopic transabdominal lateral versus posterior retroperitoneal adrenalectomy. surgery. 2009 oct. 146 (4): 621 - 5; discussion 625 - 6. [ medline ] .
cianci p, fersini a, tartaglia n, altamura a, lizzi v, stoppino lp, et al. spleen assessment after laparoscopic transperitoneal left adrenalectomy: preliminary results. surg endosc. 2016 apr. 30 (4): 1503 - 7. [ medline ] .
adrenal surgery has a long history, with the first planned adrenalectomy performed in 1914 by sargent. [ 2 ] chrles mayo performed the first flank approach for pheochromocytoma in 1927, though at the time of surgery, he was unaware of the full disease process involved. through the early to mid - 1900s, multiple changes in surgical approaches to the adrenal gland were developed to augment several posterior and anterior approaches. for decades, little change to adrenal surgery was seen, until the first laparoscopic adrenalectomy was described by gagner in 1992. [ 3 ]
the choice of approach will depend on the size and location of the mass, the possibility of malignancy, and the surgeon' s experience with the different techniques. the open approach to adrenalectomy is considered the gold standard for masses suspected of being adrenal carcinoma. [ 2 ]
gallagher sf, wahi m, haines kl, baksh k, enriquez j, lee tm. trends in adrenalectomy rates, indications, and physician volume: a statewide analysis of 1816 adrenalectomies. surgery. 2007 dec. 142 (6): 1011. [ medline ] .
palazzo ff, sebag f, sierra m, ippolito g, souteyrand p, henry jf. long - term outcome following laparoscopic adrenalectomy for large solid adrenal cortex tumors. world j surg. 2006 may. 30 (5): 893 - 8. [ medline ] .
arghami a, dy bm, bingener j, osborn j, richards ml. single - port robotic - assisted adrenalectomy: feasibility, safety, and cost - effectiveness. jsls. 2015 jan - mar. 19 (1): e2014. 00218. [ medline ] .
shen wt, grogan r, vriens m, clark oh, duh qy. one hundred two patients with pheochromocytoma treated at a single institution since the introduction of laparoscopic adrenalectomy. arch surg. 2010 sep. 145 (9): 893 - 7. [ medline ] .
tai ck, li sk, hou sm, fan cw, fung tc, wah mk. laparoscopic adrenalectomy: comparison of lateral transperitoneal and lateral retroperitoneal approaches. surg laparosc endosc percutan tech. 2006 jun. 16 (3): 141 - 5. [ medline ] .
most adrenal tumors are noncancerous (benign). you may require surgery to remove an adrenal gland if the tumor is producing excess hormones or is large in size (more than 2 inches or 4 to 5 centimeters). you may also require surgery if the tumor is cancerous (malignant) or suspected to be cancerous. this surgery is called adrenalectomy (uh - dree - nul - ek - tuh - me). you may also need an adrenalectomy to remove cancer that has spread (metastasized) from another location, such as the kidney or lung .
saunders bd, wainess rm, dimick jb, upchurch gr, doherty gm, gauger pg. trends in utilization of adrenalectomy in the united states: have indications changed? . world j surg. 2004 nov. 28 (11): 1169 - 75. [ medline ] .
thompson gb, grant cs, van heerden ja, schlinkert rt, young wf jr, farley dr. laparoscopic versus open posterior adrenalectomy: a case - control study of 100 patients. surgery. 1997 dec. 122 (6): 1132 - 6. [ medline ] .
chiang ph, yu cj, lee wc, wang hj, hsu wc. comparison of retroperitoneoscopic and transperitoneal laparoscopic adrenalectomy for right - sided benign tumors: a single - institute experience. urol int. 2015. 94 (2): 144 - 8. [ medline ] .
ramírez - plaza cp, perales jl, camero nm, rodríguez - cañete a, bondía - navarro ja, santoyo - santoyo j. outpatient laparoscopic adrenalectomy: a new step ahead. surg endosc. 2011 aug. 25 (8): 2570 - 3. [ medline ] .
as a result, the only absolute contraindication for laparoscopic adrenalectomy in experienced hands is suspected adrenocortical carcinoma with extension into surrounding organs. in this setting, the open approach facilitates an en - bloc excision of all involved viscera and affords an increased chance of cure. [ 20, 21 ]
zhang x, shi tp, li hz, ma x, wang bj. laparo - endoscopic single site anatomical retroperitoneoscopic adrenalectomy using conventional instruments: initial experience and short - term outcome. j urol. 2011 feb. 185 (2): 401 - 6. [ medline ] .
porpiglia f, fiori c, daffara f, zaggia b, bollito e, volante m. retrospective evaluation of the outcome of open versus laparoscopic adrenalectomy for stage i and ii adrenocortical cancer. eur urol. 2010 may. 57 (5): 873 - 8. [ medline ] .
moreno p, de la quintana basarrate a, musholt tj, paunovic i, puccini m, vidal o, et al. adrenalectomy for solid tumor metastases: results of a multicenter european study. surgery. 2013 dec. 154 (6): 1215 - 23. [ medline ] .
gockel i, kneist w, heintz a, beyer j, junginger t. endoscopic adrenalectomy: an analysis of the transperitoneal and retroperitoneal approaches and results of a prospective follow - up study. surg endosc. 2005 apr. 19 (4): 569 - 73. [ medline ] .
hemorrhage from the adrenal vein or ivc is one of the most feared complications of a laparoscopic right adrenalectomy. if bleeding from the adrenal vein or ivc is suspected, direct pressure usually tamponades it. during this time, planning for permanent control either by a laparoscopic or open approach can be done .
brix d, allolio b, fenske w, agha a, dralle h, jurowich c, et al. laparoscopic versus open adrenalectomy for adrenocortical carcinoma: surgical and oncologic outcome in 152 patients. eur urol. 2010 oct. 58 (4): 609 - 15. [ medline ] .
chung sd, huang cy, wang sm, tai hc, tsai yc, chueh sc. laparoendoscopic single - site (less) retroperitoneal adrenalectomy using a homemade single - access platform and standard laparoscopic instruments. surg endosc. 2011 apr. 25 (4): 1251 - 6. [ medline ] .
research has shown that the risk of complications in surgery is directly related to the surgeon' s experience. since adrenal surgery is relatively uncommon, it is critical to find a surgeon who specializes in this type of operation. in experienced hands, the risks of adrenal surgery, especially laparoscopic adrenalectomy, are low .
autorino r, bove p, de sio m, miano r, micali s, cindolo l, et al. open versus laparoscopic adrenalectomy for adrenocortical carcinoma: a meta - analysis of surgical and oncological outcomes. ann surg oncol. 2016 apr. 23 (4): 1195 - 202. [ medline ] .
lee j, el - tamer m, schifftner t, turrentine fe, henderson wg, khuri s. open and laparoscopic adrenalectomy: analysis of the national surgical quality improvement program. j am coll surg. 2008 may. 206 (5): 953 - 9; discussion 959 - 61. [ medline ] .
an adrenalectomy is a surgical procedure to remove one or both of the adrenal glands. there are two adrenal glands in the body, located on top of the kidneys. one or both adrenal glands may be removed depending on the nature of the disease. common reasons why the adrenal gland may need to be removed include :
vidal o, astudillo e, valentini m, ginestá c, espert jj, gracía - valdecasas jc, et al. single - port laparoscopic left adrenalectomy (sils): 3 years' experience of a single institution. surg laparosc endosc percutan tech. 2014 oct. 24 (5): 440 - 3. [ medline ] .
despite this, surgeon preference and experience are the most important factors impacting surgical technique selection. the vast majority of the literature does not demonstrate any significant advantages when the two approaches are directly compared. [ 33, 34, 35, 36, 37 ] some experience suggests that a single - incision laparoscopic approach to left adrenalectomy may yield results comparable to those of a conventional laparoscopic approach. [ 27 ]
while most adrenal tumors can be removed laparoscopically, certain adrenal tumors should be removed through a traditional open operation. larger tumors (usually over 10 to 15 centimeters in size) and tumors that are thought to be adrenocortical cancer are usually removed through an open operation. patients undergoing open adrenalectomy often remain in the hospital for a few days after the operation. depending on the size and type of tumor, there are three types of open operations :
in current practice, laparoscopic adrenalectomy has generally been contraindicated in lesions 12 cm and larger. [ 17, 18 ] nevertheless, the laparoscopic approach has been used in large adrenal masses up to 17 cm. in a report by boylu et al, [ 19 ] the use of the laparoscopic approach in lesions larger than 8 cm resulted in longer operating times and higher blood loss but was comparable when hospital stay, open conversion rate, and pathologic outcome were compared .
a commonly accepted indication for laparoscopic adrenalectomy is hormonally active tumors, including aldosteronomas, pheochromocytomas, and cortisol - producing adrenal tumors. other indications involve size criteria and include nonfunctioning tumors less than 4 - 6 cm in diameter and smaller nonfunctioning tumors with rapid or progressive growth. although no definitive size criteria for removal of nonfunctioning adrenal masses exist, it is well accepted that tumors larger than 6 cm should be removed because of an increased incidence of cancer with increasing size. [ 22 ]
other reports cited a 5 - year survival rate in the area of 33% . [ 15 ] when stratified for stage, 5 - year survival is 20 - 45% for stage i adrenal tumors, 12. 5 - 57% for stage ii adrenal tumors, 5 - 18% for stage iii adrenal tumors, and 0% for stage iv adrenal tumors. [ 16 ] the most significant predictors of outcome after adrenalectomy for carcinoma are stage at presentation and complete resection. [ 17 ]
the incidence of these incidentally noted adrenal masses has been estimated to be around 5% . [ 4, 5, 6, 2, 7 ] autopsy studies have supported this estimation, showing the incidence of adrenal masses found at autopsy to also be around 3 - 5% . [ 5, 2, 8 ] furthermore, studies of hospital discharges showed a 43. 4% increase in adrenalectomy rates from 1988 to 2000. [ 7, 9 ] with increasing diagnosis and treatment of adrenal masses, optimization of cure and minimization of morbidity is very important .
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perched on top of each of your kidneys, your adrenal glands produce hormones that help regulate your metabolism, immune system, blood pressure and other essential functions. although small, these glands dictate much of what happens in your body .
one adrenal gland sits above each of your kidneys. your two adrenal glands produce various hormones that help regulate your metabolism, immune system, blood pressure, blood sugar and other essential functions .
if both adrenal glands are removed, you will need to take supplemental hormone medications. if only one gland is removed, the other will take over full function without the need for ongoing medications .
minimally invasive surgery. endocrine surgeons at mayo clinic are often able to use minimally invasive (laparoscopic) surgery for tumors of the adrenal gland because the gland is relatively small. laparoscopic surgery has many benefits, including smaller scars, less pain and a shorter recovery period than traditional open surgery .
open surgery. doctors usually reserve open surgery for large or cancerous (malignant) tumors. they perform open surgery using traditional instruments and incisions .
cryoablation. in addition, mayo clinic doctors may use cryoablation to treat adrenal tumors. this procedure uses ct imaging to guide the insertion of a probe that freezes and destroys adrenal tumors. interventional radiologists may use cryoablation as a treatment option for small tumors that have spread to the adrenal gland (metastasis), particularly when surgery carries a high risk .
urologic conditions. what are adrenal gland cancers? american urological association. urltoken accessed aug. 20, 2017 .
wein aj, et al. , eds. surgery of adrenal glands. in: campbell - walsh urology. 11th ed. philadelphia, pa. : elsevier; 2016. https: / / www. clinicalkey. com. accessed aug. 21, 2017 .
warner kj. allscripts epsi. mayo clinic, rochester, minn. june 15, 2017 .
nippoldt tb (expert opinion). mayo clinic, rochester, minn. aug. 29, 2017 .
mckenzie tj (expert opinion). mayo clinic, rochester, minn. sept. 5, 2017 .
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author: peter p stuhldreher, md; chief editor: kurt e roberts, md more ...
increasing use of imaging technologies, such as computed tomography (ct) and magnetic resonance imaging (mri), for aid in diagnosis of other conditions has led to increased diagnosis of adrenal masses .
masses larger than 6 cm have a rate of adrenocortical carcinoma of 25% and should be managed surgically. [ 8 ] masses smaller than 4 cm may be safely observed because their rate of adrenocortical carcinoma is 2% . [ 8 ]
size categories, however, do not alter management for hormonally active lesions; these should also be managed with surgical excision in most cases. the adrenal gland can be a common site for metastases, so patients with known primary malignancies should be managed according to guidelines for the primary malignancy by stage and grade. for example, the adrenal gland is a common site for synchronous or metachronous metastasis from renal cell carcinoma; surgical excision can frequently offer primary cure in conjunction with nephrectomy. [ 11 ]
the adrenal glands are paired glands superior to the kidneys bilaterally (see the image below) that reside within a separated layer of gerota fascia, and they provide multiple functions in the body. (see the image below. )
the outer layer (cortex) of the gland contributes to homeostasis via its endocrine function, secreting cortisol, aldosterone, and dehydroepiandrosterone (dhea). these hormones play pivotal roles in regulating salt and water balance, and in the case of dhea add virilization hormones to the hormonal milieu. the inner layer (adrenal medulla) is derived from neural crest cells and is important in the sympathetic regulation of the body by secreting norepinephrine. there are several known disorders of adrenal metabolism that involve hypersecretion of these different molecules .
for more information about the relevant anatomy, see suprarenal (adrenal) gland anatomy .
before operative intervention, treatment for appropriate coagulopathies and for hormonal excess should be instituted. serum potassium levels should be corrected in hyperaldosteronism, and hypertension control should be initiated .
if cortisol excess is severe, inhibition of cortisol with ketoconazole, mitotane, or metyrapone should be considered. in addition, good glucose control is necessary, and operative replacement of steroids is indicated; the hypothalamic - pituitary - adrenal axis for the normal contralateral adrenal gland will remain suppressed for some time after removal of the abnormal adrenal tissue .
for pheochromocytoma, initiation of alpha blockade with either phenoxybenzamine or prazosin is an absolute necessity to protect the patient from the sympathetic surges possible with manipulation of the mass during surgery. for the same purpose, some authors have advocated preoperative use of calcium - channel blockers. in addition, vascular volume reexpansion is often necessary because of volume contraction with hypersympathetic states .
the posterior lumbodorsal approach is also associated with high rates of neuromuscular morbidity, including chronic pain (14 %), laxity in flank muscles (30 %), and flank numbness (10 %). [ 13 ]
outcomes for benign lesions, including hormone - secreting lesions, are excellent. resolution of symptoms is achieved in nearly all patients, except those who have contralateral disease or sites of metastasis (in the case of pheochromocytoma) .
prager g, heinz - peer g, passler c, kaczirek k, schindl m, scheuba c, et al. surgical strategy in adrenal masses. eur j radiol. 2002 jan. 41 (1): 70 - 7. [ medline ] .
jossart gh, burpee se, gagner m. surgery of the adrenal glands. endocrinol metab clin north am. 2000 mar. 29 (1): 57 - 68, viii. [ medline ] .
barzon l, boscaro m. diagnosis and management of adrenal incidentalomas. j urol. 2000 feb. 163 (2): 398 - 407. [ medline ] .
grumbach mm, biller bm, braunstein gd, campbell kk, carney ja, godley pa. management of the clinically inapparent adrenal mass (
incidentaloma
). ann intern med. 2003 mar 4. 138 (5): 424 - 9. [ medline ] .
graham dj, mchenry cr. the adrenal incidentaloma: guidelines for evaluation and recommendations for management. surg oncol clin n am. 1998 oct. 7 (4): 749 - 64. [ medline ] .
itano nb, blute ml, spotts b, zincke h. outcome of isolated renal cell carcinoma fossa recurrence after nephrectomy. j urol. 2000 aug. 164 (2): 322 - 5. [ medline ] .
ranvier gg, inabnet wb 3rd. surgical management of adrenocortical carcinoma. endocrinol metab clin north am. 2015 jun. 44 (2): 435 - 52. [ medline ] .
blumenfeld jd, sealey je, schlussel y, vaughan ed jr, sos ta, atlas sa. diagnosis and treatment of primary hyperaldosteronism. ann intern med. 1994 dec 1. 121 (11): 877 - 85. [ medline ] .
vassilopoulou - sellin r, schultz pn. adrenocortical carcinoma. clinical outcome at the end of the 20th century. cancer. 2001 sep 1. 92 (5): 1113 - 21. [ medline ] .
ng l, libertino jm. adrenocortical carcinoma: diagnosis, evaluation and treatment. j urol. 2003 jan. 169 (1): 5 - 11. [ medline ] .
lee je, berger dh, el - naggar ak, hickey rc, vassilopoulou - sellin r, gagel rf. surgical management, dna content, and patient survival in adrenal cortical carcinoma. surgery. 1995 dec. 118 (6): 1090 - 8. [ medline ] .
ekici s, ciancio g. surgical management of large adrenal masses with or without thrombus extending into the inferior vena cava. j urol. 2004 dec. 172 (6 pt 1): 2340 - 3. [ medline ] .
barzon l, scaroni c, sonino n, fallo f, gregianin m, macri c. incidentally discovered adrenal tumors: endocrine and scintigraphic correlates. j clin endocrinol metab. 1998 jan. 83 (1): 55 - 62. [ medline ] .
copeland pm. the incidentally discovered adrenal mass. ann surg. 1984 jan. 199 (1): 116 - 22. [ medline ] .
kloos rt, gross md, francis ir, korobkin m, shapiro b. incidentally discovered adrenal masses. endocr rev. 1995 aug. 16 (4): 460 - 84. [ medline ] .
osella g, terzolo m, borretta g, magro g, ali a, piovesan a. endocrine evaluation of incidentally discovered adrenal masses (incidentalomas). j clin endocrinol metab. 1994 dec. 79 (6): 1532 - 9. [ medline ] .
ross ns, aron dc. hormonal evaluation of the patient with an incidentally discovered adrenal mass. n engl j med. 1990 nov 15. 323 (20): 1401 - 5. [ medline ] .
wein aj, kavoussi lr, novick ac et al. campbell - walsh urology. philadelphia: saunders, elsevier; 2007. 1868 - 1888 .
peter p stuhldreher, md resident physician in urology, urology institute, university hospitals, case medical center disclosure: nothing to disclose .
edward e cherullo, md director, urology residency program, vice chair, clinical operations, associate professor of urology, urologic institute, case western reserve university school of medicine edward e cherullo, md is a member of the following medical societies: alpha omega alpha, american urological association, indiana state medical association, ohio urological society, society of urology chairpersons and program directors, american association of clinical urologists disclosure: nothing to disclose .
kurt e roberts, md assistant professor, section of surgical gastroenterology, department of surgery, director, surgical endoscopy, associate director, surgical skills and simulation center and surgical clerkship, yale university school of medicine kurt e roberts, md is a member of the following medical societies: american college of surgeons, society of american gastrointestinal and endoscopic surgeons, society of laparoendoscopic surgeons disclosure: nothing to disclose .
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author: william w hope, md; chief editor: kurt e roberts, md more ...
relative contraindications to the laparoscopic transperitoneal approach include patients who have had extensive previous abdominal surgery and pregnant patients. in patients with previous abdominal surgery, a laparoscopic retroperitoneal approach may be beneficial .
the adrenal glands, also known as suprarenal glands, belong to the endocrine system. (see suprarenal (adrenal) gland anatomy .) they are a pair of triangular - shaped glands, each about 5 cm (2 in .) long and 2. 5 cm (1 in .) wide, that sit on top of the kidneys. the suprarenal glands are responsible for the release of hormones that regulate metabolism, immune system function, and the salt - water balance in the bloodstream; they also aid in the body’s response to stress .
each suprarenal gland is composed of two distinct tissues: the suprarenal cortex and the suprarenal medulla. the suprarenal cortex serves as the outer layer of the suprarenal gland, and the suprarenal medulla serves as the inner layer. these two major regions are encapsulated by connective tissue known as the capsule .
although many arterial branches supply the adrenal gland, most can be well controlled by using electrosurgical devices. when manipulating and removing the adrenal gland, caution must be used not to disrupt the capsule, as this can cause bleeding and potential spillage of malignant cells. although bleeding from the adrenal gland itself usually is not hemodynamically significant, it often is a nuisance, disrupting visualization for the finer dissection and making it difficult to find the correct surgical planes .
in patients with functional tumors, consultation with an endocrinologist and an anesthesiologist is crucial for adequately preparing patients for surgery and avoiding intraoperative crises, most notably severe hypertension. alpha blockade should be given to all patients with pheochromocytoma before surgery, followed by beta blockade only in patients with tachycardia .
schulick rd, brennan mf. long - term survival after complete resection and repeat resection in patients with adrenocortical carcinoma. ann surg oncol. 1999 dec. 6 (8): 719 - 26. [ medline ] .
schulick rd, brennan mf. adrenocortical carcinoma. world j urol. 1999 feb. 17 (1): 26 - 34. [ medline ] .
miller bs, ammori jb, gauger pg, broome jt, hammer gd, doherty gm. laparoscopic resection is inappropriate in patients with known or suspected adrenocortical carcinoma. world j surg. 2010 jun. 34 (6): 1380 - 5. [ medline ] .
gonzalez rj, shapiro s, sarlis n, vassilopoulou - sellin r, perrier nd, evans db. laparoscopic resection of adrenal cortical carcinoma: a cautionary note. surgery. 2005 dec. 138 (6): 1078 - 85; discussion 1085 - 6. [ medline ] .
[ guideline ] stefanidis d, goldfarb m, kercher kw, hope ww, richardson w, fanelli rd. sages guidelines for minimally invasive treatment of adrenal pathology. surg endosc. 2013 nov. 27 (11): 3960 - 80. [ medline ] .
lee cw, salem ai, schneider df, et al. minimally invasive resection of adrenocortical carcinoma: a multi - institutional study of 201 patients. j gastrointest surg. 2017 feb. 21 (2): 352 - 362. [ medline ]. [ full text ] .
belldegrun a, hussain s, seltzer se, loughlin kr, gittes rf, richie jp. incidentally discovered mass of the adrenal gland. surg gynecol obstet. 1986 sep. 163 (3): 203 - 8. [ medline ] .
podolsky er, curcillo pg 2nd. single port access (spa) surgery - - a 24 - month experience. j gastrointest surg. 2010 may. 14 (5): 759 - 67. [ medline ] .
mindy lee nace merritt, md resident physician, department of surgery, southeastern area health education center, new hanover regional medical center, wilmington, nc mindy lee nace merritt, md is a member of the following medical societies: american medical association disclosure: nothing to disclose .
james a harris, md coastal surgery specialists james a harris, md is a member of the following medical societies: american college of surgeons, society for surgery of the alimentary tract, society of american gastrointestinal and endoscopic surgeons, society of laparoendoscopic surgeons, southeastern surgical congress, american society of general surgeons disclosure: nothing to disclose .
mary l windle, pharmd adjunct associate professor, university of nebraska medical center college of pharmacy; editor - in - chief, medscape drug reference disclosure: nothing to disclose .
medscape reference thanks william w hope, md, assistant professor of surgery, university of north carolina at chapel hill school of medicine; director of surgical education, department of surgery, new hanover regional medical center / south east area health education center, for assistance with the video contribution to this article .
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size of tumor larger tumors are more likely to be cancer. this may require a larger incision for a more thorough dissection and removal of the cancer, including other organs it may be attached to .
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 .
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 .
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 .
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the adrenal glands are two small organs, one located above each kidney. they are triangular in shape and about the size of a thumb. the adrenal glands are known as endocrine glands because they produce hormones. these hormones are involved in control of blood pressure, chemical levels in the blood, water use in the body, glucose usage, and the “fight or flight” reaction during times of stress. these adrenal - produced hormones include cortisol, aldosterone, the adrenaline hormones – epinephrine and norepinephrine – and a small fraction of the body’s sex hormones (estrogen and androgens) .
patients with adrenal gland problems may have a variety of symptoms related to excess hormone production by the abnormal gland. adrenal tumors associated with excess hormone production include pheochromocytomas, aldosterone - producing tumors, and cortisol - producing tumors. some of these tumors and their typical features are given below .
pheochromocytomas produce excess hormones that can cause very high blood pressure and periodic spells characterized by severe headaches, excessive sweating, anxiety, palpitations, and rapid heart rate that may last from a few seconds to several minutes .
aldosterone producing tumors cause high blood pressure and low serum (blood) potassium levels. in some patients this may result in symptoms of weakness, fatigue, and frequent urination .
cortisol producing tumors cause a syndrome termed cushing’s syndrome that can be characterized by obesity (especially of the face and trunk), high blood sugar, high blood pressure, menstrual irregularities, fragile skin, and prominent stretch marks. most cases of cushing’s syndrome, however, are caused by small pituitary tumors and are not treated by adrenal gland removal. overall, adrenal tumors account for about 20% of cases of cushing’s syndrome .
an incidentally found mass in the adrenal may be any of the above types of tumors, or may produce no hormones at all. most incidentally found adrenal masses do not make excess hormones, cause no symptoms, are benign, and do not need to be removed. surgical removal of incidentally discovered adrenal tumors is indicated only if:
adrenalectomy is the surgical removal of one or both ( bilateral adrenalectomy ) adrenal glands . it is usually advised for patients with tumors of the adrenal glands . the procedure can be performed using an open incision ( laparotomy ) or laparoscopic technique . 
adrenalectomy is the surgical removal of one or both (bilateral adrenalectomy) adrenal glands. it is usually advised for patients with tumors of the adrenal glands. the procedure can be performed using an open incision (laparotomy) or laparoscopic technique.
adrenalectomy is the surgical removal of one or both (bilateral adrenalectomy) adrenal glands. it is usually advised for patients with tumors of the adrenal glands. the procedure can be performed using an open incision (laparotomy) or laparoscopic technique.