CONSULTANT
CONSULTANT
Jewel Urology Center, Mumbai
Nanavati Hospital, Mumbai
Saifee Hospital, Mumbai
DR. VIVEK VENKAT
Compassionate Evidence-Based Ethical Cancer Care
docvivek@gmail.com
WHAT IS ADRENALECTOMY?
- Adrenalectomy is a surgery where the adrenal gland is completely removed.
- It can be done by an open incision or via a minimally-invasive laparoscopic or robotic approach.
WHEN IS ADRENALECTOMY NEEDED?
- Any adrenal mass which is secreting hormones like noradrenaline (pheochromocytoma), corticosteroids (Cushing’s disease), aldosterone (Conn’s syndrome) needs to be removed. This can cure the patient of their illness.
- Any adrenal mass more than 4-5cms has a risk of malignancy and should be removed whether or not it is producing hormones.
- Any mass suspicious for malignancy needs to be removed.
ADVANTAGES OF ROBOTIC SURGERY
- Smaller incisions with less pain and scarring
- Shorter hospital stay and quick return to normal activities
- Reduced bleeding and blood transfusion rates
- Lower risk for wound infection
- Excellent magnified view allowing precise closure of blood vessels and collecting system in the tumor bed and closure of the remaining kidney
- Much more ergonomic than laparoscopy
Robotic surgery provides significant benefits for both patient and surgeon.
HOW TO PREPARE FOR ADRENALECTOMY?
- Basic blood and urine tests to assess fitness for surgery
- Cardiac evaluation like ECG and 2D-Echo
- To stop blood thinning medication for 5-7 days before the surgery.
- Anesthesia check-up and assessment.
- Healthy diet and exercise until the surgery.
- Admission the day prior or day of surgery.
- IV fluids are needed for patients with pheochromocytoma
The first step is to determine whether or not the adrenal tumor is producing hormones.
This involves a number of urine and blood tests and will be done by your Endocrinologist.
Depending on the results medications are generally needed to block the overactive hormones to prepare you for surgery.
In case of pheochromocytoma this can take 2-4 weeks of preparation prior to the surgery.
To proceed with surgery the general instructions are:
WHAT TO EXPECT AFTER ADRENALECTOMY SURGERY?
- Speed of recovery depends on the extent of the surgery
- After most robotic cases resumption of a liquid diet is within 6-8 hours after surgery and normal food the next day
- You will also be able to get out of bed and walk a few hours after surgery.
- Pain after robotic surgery is mild and easily controlled with medications. For open surgery and more extensive cases stronger painkillers or epidural analgesia may be needed
- Some patients may be kept in the ICU for observation for 1-2 days (especially pheochromocytoma)
- You will have a urinary catheter to drain the bladder for 1-2 days.
- Most patients undergoing robotic surgery are discharged in 1-2 days. Open cases or more extensive surgeries may need a longer post-operative stay of 3-7 days
- You can resume light work in about 4 weeks after surgery.
- You can walk as much as you like but we recommend avoiding strenuous activity like lifting weights, golfing, going to the gym, etc. for 6 weeks after surgery.
WHAT ARE THE RESULTS OF ADRENALECTOMY?
- Most adrenal tumors are benign and patients are cured with the surgery.
- Once the offending adrenal is removed all symptoms of hormone excess get reversed and the patient can potentially be free of medications. Some patients may need to continue lower doses or fewer medicines than before surgery.
- Adrenal cancers which are small and localized do well with surgery. Larger tumors will likely need chemotherapy.
- Robotic surgery has much lower complications and quicker recovery than open surgery.
- Once the biopsy report is available you can discuss the follow-up schedule and tests with your uro-oncologist and endocrinologist.
WHAT ARE THE COMPLICATIONS OF ADRENALECTOMY?
- Bleeding – The adrenal is a very vascular organ. Bleeding is a significant risk in these surgeries especially with large tumors and transfusion may be required.
- Injury to adjacent organs – In cases of large tumors, adjacent organs like the kidney, spleen, tail of pancreas, intestines, etc. may be stuck to the tumor. Sometimes this cannot be conclusively seen on the CT scan or MRI and the organs may need to be removed during the procedure.
- Delay in the recovery of intestinal function (ileus) – This can happen after more extensive surgeries and may take up to a week to resolve sometimes.
- Blood pressure fluctuations and cardiac problems – This is a significant risk in patients with pheochromocytoma and may need ICU monitoring after surgery.
Tumors of the adrenal gland which are secreting hormones and causing symptoms need to be removed. Non-secreting tumors >4-5cm should also be removed because of the risk of cancer.
It allows a very precise surgery with fewer complications, better functional outcomes and no compromise in cancer control.
Pain is quite mild and easily managed with tablet medications. Open surgery of more extensive procedures may require stronger medications or epidural analgesia.
Most patients are discharged in 2-3 days after the surgery however this can take longer and depends on the extent of the procedure.
Work can be resumed usually 3-4 weeks after surgery.
Usually no additional treatment is needed.
Jewel Urology Center
No. 89, N. S. Road Number 1,
Navpada, JVPD Scheme,
Andheri West
Mumbai 400049, India
(m):+919136041545
Visiting Hours : Mon-Sat 4.30 - 6 pm
By appointments only
Email: appointments@drvivekvenkat.com
Phone:+919136041545
Whatsapp: +919136041545
Nanavati Max Hospital
S.V road, Vile Parle west
Mumbai 400056, India
Visiting Hours : Mon-Sat 2 - 4.30 pm
Email: appointments@drvivekvenkat.com
Phone:+919136041545
Whatsapp: +919136041545
Saifee Hospital
15/17, Maharshi Karve Rd,
Opposite Charni Road Station East,
Mumbai 400004, India
(m):+919136041545
Visiting Hours : Thursday 11am - 1 pm
By appointments only
Email: appointments@drvivekvenkat.com
Phone:+919136041545
Whatsapp: +919136041545
