Our Summary

This research paper is looking at a type of surgery called bilateral adrenalectomy, which is when both adrenal glands are removed. The adrenal glands are small glands located on top of each kidney. They produce hormones that help regulate your metabolism, immune system, blood pressure, response to stress and other essential functions.

The authors of this study looked back over the medical records of 23 patients who had this surgery between 2005 and 2016. These patients had various health conditions that led to the need for the surgery, including Cushing’s disease, hereditary phaeochromocytomas, adrenocortical cancer, colorectal metastatic disease, and adrenocortical adenomas.

The surgery was done using a laparoscopic approach in most cases, which is a type of surgery where small incisions are made and a camera is used to guide the surgery. This was done in 17 out of the 23 patients. The rest of the patients had open surgery.

The study found that the average time for the laparoscopic surgery was about 195 minutes, while open surgery took longer - about 243 minutes on average. Cushing’s disease patients had shorter surgery times compared to patients with phaeochromocytomas.

After surgery, patients stayed in the hospital for about 5 days on average. There were some complications after surgery, including chest infection, postoperative bleeding, chest drain for pneumothorax, postoperative cardiac arrests and one late cancer death from complications related to uncontrolled hypercortisolism.

The authors concluded that this type of bilateral adrenalectomy surgery is not very common, but the laparoscopic approach can be used in most cases. They also suggested that the retroperitoneoscopic approach, which is a different type of minimally invasive surgery, might become the standard approach for these types of operations in the future.

FAQs

  1. What is the most common method of performing a bilateral adrenalectomy according to the study?
  2. What conditions typically require a bilateral adrenalectomy according to the study?
  3. What was the median length of hospital stay for patients undergoing a bilateral adrenalectomy in this study?

Doctor’s Tip

One helpful tip a doctor might tell a patient about adrenalectomy is to carefully follow postoperative instructions, including taking prescribed medications, attending follow-up appointments, and reporting any concerning symptoms promptly. It is important to monitor for signs of infection, bleeding, or other complications and to communicate with your healthcare team if you have any questions or concerns. Additionally, maintaining a healthy lifestyle, including regular exercise and a balanced diet, can help support recovery and overall well-being after surgery.

Suitable For

Patients who are typically recommended for adrenalectomy include those with Cushing’s disease, hereditary phaeochromocytomas, adrenocortical cancer, colorectal metastatic disease, and adrenocortical adenomas. In particular, patients with Cushing’s disease may benefit from bilateral adrenalectomy to control hypercortisolism. Additionally, patients with hereditary conditions such as Von Hippel-Lindau syndrome may require bilateral adrenalectomy for the management of multiple tumours. The laparoscopic transperitoneal approach is commonly used for bilateral adrenalectomy, with the retroperitoneoscopic approach becoming more popular. Overall, bilateral adrenalectomy is a relatively rare procedure, but can be beneficial for select patients with specific adrenal conditions.

Timeline

  • Before adrenalectomy: Patients undergo a diagnosis of their adrenal condition, which may include Cushing’s disease, hereditary phaeochromocytomas, adrenocortical cancer, metastatic disease, or adrenocortical adenomas. They may undergo various imaging tests and hormone level tests to confirm the diagnosis. Once the decision for adrenalectomy is made, the patient may undergo preoperative evaluation and counseling.

  • After adrenalectomy: The surgery is performed either laparoscopically, open, or retroperitoneoscopically, depending on the individual case. The operating time varies depending on the type of surgery and the underlying condition. Patients typically have a hospital stay of around 5 days post-surgery. Complications may occur, ranging from minor chest infections to more serious issues such as postoperative haemorrhage or cardiac arrests. Patients may also experience complications related to their underlying condition, such as uncontrolled hypercortisolism. Overall, synchronous bilateral adrenalectomy is considered a feasible operation, with laparoscopic and retroperitoneoscopic approaches becoming more common.

What to Ask Your Doctor

  1. What are the indications for a bilateral adrenalectomy in my specific case?
  2. What are the potential risks and complications associated with a bilateral adrenalectomy?
  3. What is the expected recovery time after a bilateral adrenalectomy?
  4. Will I need hormone replacement therapy after the procedure?
  5. How will a bilateral adrenalectomy impact my overall health in the long term?
  6. Are there any alternative treatment options available for my condition?
  7. How experienced is the surgical team in performing bilateral adrenalectomies?
  8. Will I need any additional tests or evaluations before the surgery?
  9. What is the success rate of bilateral adrenalectomy for my specific diagnosis?
  10. What follow-up care will be necessary after the procedure?

Reference

Authors: Maccora D, Walls GV, Sadler GP, Mihai R. Journal: Ann R Coll Surg Engl. 2017 Feb;99(2):119-122. doi: 10.1308/rcsann.2016.0266. Epub 2016 Aug 23. PMID: 27551892