Name of the Procedure:

Adrenalectomy, partial or complete, or exploration of adrenal gland with or without biopsy, transabdominal, lumbar or dorsal (separate procedure)

Summary

An adrenalectomy involves the surgical removal, partial or complete, of one or both adrenal glands. The procedure can also include the exploration of the adrenal gland, with the possibility of performing a biopsy. This surgery can be done through various approaches, including transabdominal (through the abdomen), lumbar (through the lower back), or dorsal (through the back).

Purpose

Adrenalectomy addresses issues related to adrenal gland disorders, such as tumors, overproduction of adrenal hormones, or cancers. The goal is to remove abnormal tissue, alleviate symptoms caused by hormonal imbalances, and prevent the spread of malignancy.

Indications

• Adrenal tumors (benign or malignant)
• Overproduction of adrenal hormones (e.g., Cushing's syndrome, pheochromocytoma)
• Infections or other pathology affecting the adrenal glands
• Incidental findings of adrenal masses during imaging studies

Preparation

• Fasting for a specific period before surgery, typically 6-8 hours.
• Discontinuing certain medications as advised by your doctor.
• Preoperative blood tests, imaging (CT, MRI), and possibly an endocrinology consultation.
• Discussing medical history, allergies, and current medications with the healthcare team.

Procedure Description

1. The patient is given general anesthesia for the duration of the procedure.
2. A surgical incision is made according to the chosen approach (transabdominal, lumbar, or dorsal).
3. The adrenal gland is visualized, and either partially or completely removed.
4. If necessary, a biopsy is performed on the adrenal tissue.
5. Hemostasis (control of bleeding) is achieved, and the incision is closed with sutures or staples.

Tools and Equipment

• Scalpel, surgical sutures, retractors
• Laparoscopic instruments (for minimally invasive surgery)
• Imaging tools, such as ultrasound

Anesthesia

• General anesthesia to ensure the patient is unconscious and pain-free during the procedure.

Duration

The procedure typically takes between 1 to 3 hours, depending on the complexity.

Setting

Performed in a hospital operating room or a specialized surgical center.

Personnel

• Surgeon (general or endocrine surgeon)
• Surgical nurses and assistants
• Anesthesiologist or nurse anesthetist

Risks and Complications

• Common: Pain, infection at the incision site, bleeding
• Rare: Damage to surrounding organs, adrenal insufficiency, blood clots, anesthesia-related complications

Benefits

• Removal of problematic adrenal tissue can alleviate symptoms.
• Prevents the spread of adrenal malignancies.
• Balances hormone levels, improving overall health and quality of life.

Recovery

• Hospital stay of 1-3 days, depending on the surgery type and patient's condition.
• Post-operative instructions include managing pain, avoiding heavy lifting, and keeping the incision site clean.
• Full recovery typically takes a few weeks, with follow-up appointments for monitoring.
• Gradual return to normal activities and work.

Alternatives

• Medication management for hormone-related conditions.
• Radiotherapy or chemotherapy for adrenal malignancies.
• Observation and regular monitoring for small, asymptomatic adrenal masses.
• Each alternative has its pros and cons, which should be discussed with the healthcare provider.

Patient Experience

• During: Under general anesthesia, so no awareness or pain during the procedure.
• After: Expect some pain and discomfort at the incision site, managed with pain medication.
• Comfort measures include assistance with mobility, pain management strategies, and supportive care during recovery.