Evaluations

Adrenalectomy: Indications and Options

An adrenalectomy is a surgical procedure to remove one or both of the adrenal glands.
There are two adrenal glands in the body, located on top of the kidneys. One or both adrenal glands may be removed depending on the nature of the disease.  Common reasons why the adrenal gland may need to be removed include:

• Benign adrenal tumors associated with
  • Conn's Syndrome or Hyperaldosteronism
  • Cushing's Syndrome
  • Pheochromocytoma
• Adrenal hyperplasia
• Large non-functioning adrenal tumors
  • Some adrenal tumors do not produce hormones
  • Adrenal tumors larger than 3-6 cm in size have a 10-20%  risk of cancer
  • Large adrenal tumors should be removed for that reason
• Adrenal cancer
  • Primary adrenal cancer
  • Metastatic adrenal cancer

There are two main surgical options to remove the adrenal gland.

• Open Adrenalectomy
• Laparoscopic Adrenalectomy
  
  The technique used by the surgeon is influenced by several factors:
  • Size of tumor
    Larger tumors are more likely to be cancer. This may require a larger incision for a more thorough dissection and removal of the cancer, including other organs it may be attached to.
  • Type of tumor (benign versus cancer)
    When cancer of the adrenal gland is found, the technique of choice for removing the cancer is open adrenalectomy.
  • Relationship of tumor to surrounding organs
  • History of prior abdominal surgery
    In this scenario, laparoscopic adrenalectomy may still be possible. Significant scar tissue from another surgery may limit the success of the laparoscopic technique and open adrenalectomy may be needed.
  • Experience of the surgeon
    Surgeons without training in laparoscopic surgery should not perform laparoscopic adrenalectomy.