An adrenal endocrine gland is located on the top of the upper pole of each kidney and secretes a range of hormones necessary for humans.
Specifically, adrenal medulla produces adrenaline and noradrenaline, hormones important for regulating the nervous system. The cortical portion of the adrenal produces hormones such as cortisol, aldosterone and androgens. These hormones are necessary to regulate the homeostasis of the human body and immune response. The adrenal glands can be the growth area of adenomas (benign tumors) and malignant tumors. The adrenal adenomas are benign tumors which do not metastasize to other tissues. Nevertheless, most adenomas secrete large amounts of hormones causing hormonal imbalance with significant health effects for the patients. In contrast, malignant tumors of the adrenal gland are a rare but extremely aggressive form of cancer. Regardless of the fact that the tumor is benign or malignant, the tumor is able to produce hormones that cause various events. Adrenalectomy is called the procedure during which an adrenal gland is removed.
The adrenal tumors are often recognized during the investigation of diseases associated with imbalance of hormones mentioned above. It can also be incidentally diagnosed when a computerized tomography is performed for the investigation of another health problem. Computerized tomography of the abdomen is an important diagnostic tool for adrenal tumors.
Indications for laparoscopic adrenalectomy
Laparoscopic adrenalectomy is now the procedure of choice for the removal of functional adrenal adenomas such as pheochromocytoma and adrenal non-functioning tumors. Furthermore, the laparoscopic approach is indicated for the treatment of tumors suspicious for malignancy and secondary adrenal metastases from extra-adrenal tumors. In case of preoperatively diagnosed malignancy of the adrenal tumor, laparoscopic adrenalectomy is indicated in selected cases because of the risk of local tumor spread and local recurrence.
Advantages of laparoscopic adrenalectomy-Postoperative course
The main reason that the laparoscopic approach to adrenelectomy is considered the treatment of choice is the significantly reduced morbidity compared to open surgical approach. Three abdominal or lumbar incisions are necessary for the performance of the procedure. The operative time is approximately two hour and intraoperative blood loss is minimal. The tumor is removed at the end of the procedure by one of the incisions. The patient is mobilized and eats on the first day after surgery and leaves the hospital on the second day. After 10 days the patient is fully capable to return to pre-surgery activity. The aesthetic result is excellent.
Surgical and endocrine complications are associated with laparoscopic adrenalectomy. Surgical complications are related to intra-operative bleeding, which is controlled by laparoscopic or open surgical approach. Injury to adjacent organs is a rare complication when the surgery is performed in a specialized center with extensive experience. Hormonal complications are associated with intra-operative release of large amounts of hormones in blood circulation and postoperative adrenal insufficiency following the removal of the gland. The correct preoperative preparation and postoperative patient assessment by an experienced endocrine team as well as careful surgical manipulations minimize these complications.