What Are The Adrenal Glands?
The adrenal glands are triangular-shaped glands located on top of the kidneys. They produce hormones such as estrogen, progesterone, steroids, cortisol, and cortisone, and chemicals such as adrenalin, norepinephrine, and dopamine.
The adrenal glands are small yellow-bronze organs found in the retroperitoneum, (the back of the abdomen behind the abdominal lining) usually near the top of each kidney.
They provide essential hormones that control the body's fluid and salt regulation, blood pressure, muscle development, sexual drive and development and sugar metabolism, as well as serving as the source for epinephrine, also called adrenaline. Like the kidneys, only one adrenal gland is usually required to live a normal life. The removal of an adrenal gland is an operation called, naturally enough, an adrenalectomy.
What Are Some Reasons For Having An Adrenalectomy?
Adrenalectomy is primarily done for tumors of the adrenal gland. It is performed for a variety of benign and malignant conditions, ranging from pheochromocytoma and hyperaldosteronism (primary and secondary) to adrenal cancer.
The traditional method of removal has been either through incisions on the front of the abdomen or through an incision in the lower back. Both of these incisions are occasionally associated with pain and prolonged recovery periods. The laparoscopic approach can reduce the pain and disability associated with these incisions.
When Is A Laparoscopic Approach Indicated?
For many benign conditions, especially Conn's tumors and sporadic pheochromocytoma -- both of which are benign tumors that can secrete hormones that make the patient's blood pressure extremely high -- and for hormonally inactive tumors found while looking for some other condition, laparoscopic adrenalectomy is an excellent alternative.
What Are The Symptoms For Laparoscopic Adrenalectomy ?
Everyone has two adrenal glands located directly above their kidneys. People who have problems with their adrenal glands may be completely asymptomatic or often have symptoms of high blood pressure, excess fluid retention, and heart irregularities because the adrenal glands regulate sodium (salt) and potassium levels. These symptoms may be due to a noncancerous tumor of the adrenal gland. Another type of noncancerous tumor of the adrenal gland, called a pheochromocytoma, produces excess adrenaline.
This causes headaches (severe), excess generalized sweating, racing heart, anxiety, nervousness and feelings of impending death, nervous shaking (tremors), pain in the lower chest or abdomen, nausea, weight loss, and heat intolerance. These symptoms are listed in order from the most to the least common.
What Are The Indications For Laparoscopic Adrenalectomy?
Adrenalectomy is primarily done for tumors of the adrenal gland. These may include : -
- Benign tumors of the adrenal gland that produce a hormone.
- Benign tumors of the adrenal gland that do not produce a hormone but grow or are large.
- Tumors of the adrenal gland suspicious for malignancy.
What Is Laparoscopic Adrenalectomy?
Laparoscopic adrenalectomy refers to the surgical removal of the adrenal gland through a small incision in the abdomen. A small telescope is used to visualize the adrenal gland so it can be dissected and removed through a small abdominal incision.
What Are The Contraindications To Laparoscopic Adrenalectomy?
Patients who have untreated blood clotting disorders run the increased of blood loss which would be more difficult to treat laparoscopically. Because this operation and disease processes are not common, surgeon experience with prior similar cases is an important factor in choosing this method. Patients with pheochromocytoma are usually prepared with medications for several days prior to surgery.
What Are The Risks Of Having Laparoscopic Adrenalectomy?
Laparoscopic adrenalectomy done by an experienced surgeon is a very safe procedure. As with any surgical procedure however, complications may occur. You should discuss the risks and benefits of the procedure with your surgeon.
How Is Laparoscopic Adrenalectomy Done?
Laparoscopic adrenalectomy is a surgical technique used to remove the adrenal gland without making a big incision. You will be given general anesthesia. After you are asleep, a nurse will insert a tube into your bladder to drain the urine while you are asleep. Surgery may be done with you lying on your abdomen or turned onto the side opposite the affected adrenal gland, depending on surgeon preference. Four or five small incisions will be made into the chest to give the surgeon access to the abdominal cavity. One is used for the laparoscope, which is attached to a camera that sends images to a video monitor.
The other incisions are used to hold or manipulate tissue in the abdomen. Carbon dioxide gas is insufflated into the abdominal cavity to allow room to work and to allow the surgeons to see. Parts of the adrenal gland are freed from surrounding tissue. Blood vessels to the adrenal gland are visualized, tied off or clipped with a metal clip. Once the adrenal gland is dissected free of its attachments in the abdominal cavity, it is placed in a special surgical retrieval bag and removed through one of the small abdominal incisions. At the end of the procedure, carbon dioxide gas is removed. The small incisions are closed with suture, the skin is cleaned and the incisions are covered with a small dressing.
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