Laparoscopic adrenalectomy: an explanation

What is the adrenal gland?

We all have two adrenal glands. One is on top of the right kidney and the other over the left kidney. The kidneys lie at the back of the upper part of the abdominal (tummy) cavity. The right is covered by the liver and the left by the spleen. The adrenal gland is usually removed because there is an abnormal growth in either or both of them. These growths are benign in the vast majority of cases, though about 1 in 10 can be cancerous. You will usually be asked to have the gland removed because it is functioning abnormally.

What do the adrenal glands do?

The adrenal glands are important in that they make a number of vital hormones (chemical messengers) which help us to maintain a normal blood pressure, deal with everyday events and provide the adrenaline that we feel from time to time when in a ‘flight or fight’ situation. Their function is normally tightly regulated by the nervous system; indeed they provide one way in which our brain can interact with the rest of our body. Problems may occur with the adrenal glands in that they occasionally make their hormones in large quantities; these are rare but important events as the extra hormones cause physical changes such as raised blood pressure, weight changes or a change in body shape.

How will you be prepared for the operation

Your doctor will usually refer you to a hormone specialist (endocrinologist) who will use a combination of blood and urine tests together with special scans to decide how well the adrenals are functioning. If excess hormone production is found, it will often be necessary to use tablets to counteract the effects of the hormone concerned before performing an operation. This is needed in order to ensure that the operation can be carried out safely. If it is felt that your adrenals are not working well enough, tablets may be needed to replace the missing hormones before your operation.

Such treatments are not always needed; this is something, which will be decided upon by your doctor. In some cases it is very important to continue medication several weeks before surgery in order to control the hormone levels, this can of course be a little frustrating but is a vital part of your treatment.

What happens before the operation?

Welcome to the Ward. You will be welcomed to the Ward by either nurses or the receptionist. You will be shown to your room and will be asked to change. Some basic tests such as your pulse, temperature, blood pressure, weight and urine examination will be performed. You will need to hand in any drugs or medicines you may be taking, so that your drug treatment in hospital is adjusted accordingly.
Visits by the Surgical Team. The Consultant and house surgeon will visit, interview and examine you. This may have been carried out prior to admission in the pre-admission assessment clinic. The doctors may wish you to have some special tests such as blood tests or a heart tracing (E.C.G). Your operation will again be explained to you and you will be asked to sign a consent form. If you are not clear about anything, you must as the doctor for more details.
Visit by the Anaesthetic Team. You will be seen by a member of the Anaesthetic Team, who will again interview and examine you. They will explain about the anaesthetic you will be given and will also talk to you about pain relief in the post-operative period.
Shaving. You may be asked to shave your abdomen.
Diet. You can expect to be eating normally up to 6 – 12 hours before your operation, and to be drinking up to 2 – 4 hours and then to have nothing by mouth. This is to allow your stomach to empty for the operation.
The Bowels. No special preparation is needed.
Stockings. You will be asked to wear elastic stockings (T.E.D) to prevent thrombosis (clot) during your stay.

Timing of the Operation

The nursing staff will be able to tell you approximately when you can expect to go to theatre. Do not be surprised, however, if there are changes to the exact time.

Premedication. You will be given a sedative injection and/or tablets 1 – 2 hours prior to surgery. This is to relax you and you will be advised not to get out bed unaided. You may also be given a tablet or injection to prevent vomiting.

Transfer to Theatre. You will be taken to the operating theatre on a trolley by a ward nurse and a porter. You will have been asked to change into a cotton theatre read more