Our Summary

Adrenal surgery can be a complicated procedure, especially for tumors larger than 5 cm. This research paper looks at a technique called hand-assisted laparoscopic (HAL) adrenalectomy, which uses a special device to allow surgeons to use their hands during the surgery. This technique combines the benefits of a less invasive surgery with the safety of being able to feel what’s happening during the operation. The researchers reviewed the medical records of all patients who had this surgery done by one surgeon over an 8-year period. This is the largest study of this technique to date.

The study found that of the 56 patients who had the surgery, most had benign (not cancerous) tumors. The average size of these tumors was 8 cm. Only one patient needed to switch to a more traditional surgery during the operation and there were no deaths related to the surgery. Some patients had complications after the surgery, but these were all temporary. The average hospital stay was 6 days. The researchers concluded that this technique is a safe and effective way to perform adrenal surgery, especially for larger tumors. It might also be easier for surgeons in training to learn.

FAQs

  1. What is hand-assisted laparoscopic (HAL) adrenalectomy?
  2. What were the findings of the study on HAL adrenalectomy?
  3. Is HAL adrenalectomy a safe and effective method for adrenal surgery?

Doctor’s Tip

One helpful tip a doctor might give a patient about adrenalectomy is to discuss with their surgeon the possibility of using the hand-assisted laparoscopic technique for larger tumors. This technique can offer the benefits of a less invasive surgery while also providing the surgeon with the ability to feel what is happening during the operation. Patients should also be aware of the potential for temporary complications after the surgery and discuss any concerns or questions they may have with their healthcare provider.

Suitable For

Patients who are typically recommended adrenalectomy include those with:

  1. Adrenal tumors larger than 5 cm
  2. Benign adrenal tumors
  3. Possible adrenal cancer or other adrenal gland disorders
  4. Hormone-producing adrenal tumors (e.g. pheochromocytoma, aldosteronoma, Cushing’s syndrome)
  5. Patients with symptoms such as high blood pressure, unexplained weight gain, excessive hair growth, or unexplained abdominal pain
  6. Patients who have failed medical management of their adrenal condition

It is important for patients to consult with their healthcare provider to determine if adrenalectomy is the best treatment option for their specific condition.

Timeline

Before adrenalectomy:

  1. Patient undergoes various tests such as blood tests, imaging studies (CT scan or MRI), and hormone level tests to determine the size and location of the adrenal tumor.

  2. Patient may be prescribed medications to control hormone levels or manage symptoms prior to surgery.

  3. Patient meets with the surgeon to discuss the procedure, risks, and benefits.

  4. Patient may need to follow a specific diet or fasting instructions before the surgery.

  5. Patient is instructed on what to expect during the recovery period and any potential complications.

After adrenalectomy:

  1. Patient is monitored closely in the recovery room for any immediate complications such as bleeding or infection.

  2. Patient may experience pain or discomfort at the surgical site, which can be managed with pain medications.

  3. Patient may need to stay in the hospital for a few days for observation and recovery.

  4. Patient will be instructed on how to care for the surgical incision and when to follow up with the surgeon.

  5. Patient may experience fatigue, weakness, or changes in hormone levels after surgery, which can be managed with medications and follow-up appointments.

  6. Patient will need to follow up with the surgeon for regular check-ups and monitoring of hormone levels to ensure the success of the surgery.

What to Ask Your Doctor

Some questions a patient should ask their doctor about adrenalectomy include:

  1. What are the potential risks and complications associated with adrenalectomy?
  2. How long will recovery take after the surgery?
  3. Will I need to take medication or make lifestyle changes after the surgery?
  4. How experienced are you in performing adrenalectomy procedures?
  5. Are there any alternative treatment options for my condition?
  6. What is the success rate for this type of surgery in treating adrenal tumors?
  7. Will I need any additional tests or imaging before the surgery?
  8. How will the surgery be performed (laparoscopic, open, hand-assisted laparoscopic, etc.)?
  9. What are the potential long-term effects of having one adrenal gland removed?
  10. How often will I need follow-up appointments after the surgery?

Reference

Authors: Buxton J, Vun SH, van Dellen D, Wadsworth R, Augustine T. Journal: Clin Endocrinol (Oxf). 2019 Jan;90(1):74-78. doi: 10.1111/cen.13883. Epub 2018 Nov 15. PMID: 30346641