The adrenal glands are two small, wedge shaped glands that rest above the upper inside edge of the kidneys in the tissues behind the organs of the abdominal cavity. These glands produce hormones that have important functions in controlling the blood pressure and in controlling how much salt and water are in the circulation. They are also the body’s only source of cortisone, another hormone that has a critical role in normal cell function. Usually, only one normal adrenal gland is necessary for satisfactory adrenal function.

Surgical removal of the adrenal glands is undertaken for a number of reasons. On occasion, tumors develop in the adrenal glands and the gland and tumor must be removed. Sometimes this is to prevent progression to cancer, or to treat early cancers.

Some benign tumors produce large amounts of hormones normally produced by the adrenal but since there is an excess of hormone, patients can suffer the effects of excessive hormone. Examples include a cortisone-secreting tumor leading to Cushing’s syndrome, aldosterone secreting tumor leading to low potassium and hypertension, or epinephrine-secreting tumors called pheochromocytoma that are also associated with unpredictable but potentially dangerous levels of hypertension. Removal of the gland and tumor in each of these situations is curative, except in malignant tumors where there is always a chance of spread.

Traditional techniques for adrenalectomy on either the right or the left require a large anterior abdominal wall incision with a prolonged recovery. An approach through the back, opening and splitting the space around the 11th or 12th ribs through a smaller incision has also been developed and while effective, appears to have an increased incidence of persistent side effects, especially hernia formation and pain.

The most recent technical innovations with respect to the surgical management of adrenal disease are laparoscopic approaches to the adrenal gland. Several small incisions are made to allow the surgeon to insert a camera and instruments. This technique has been very successfully applied at a number of centers around the United States. Prior surgeries in the area, obesity, proven malignancy, intolerance of the laparoscopic position or technique, and some very large tumors have proven to be contraindications to the technique.

Who is a Candidate for Laparoscopic Adrenalectomy?

• Tumors less than 10 cm in diameter (~ 4 inches). Tumors larger than this are more likely to be cancerous and therefore require better exposure and a more aggressive operation. Tumors larger than this also pose a technical problem because the surgeon has difficulty seeing around it with the camera.
• Tumors which secrete hormone. These masses are ideally suited for this approach.
• Pheochromocytomas. Pheochromocytomas are tumors which arise from the central zone of the adrenal gland (the medulla) and secrete epinephrine (adrenaline). Since they are usually small and benign, they can be removed with great success using this minimally invasive approach.
• Tumors which do not secrete hormone...if they are greater than 4 cm (~ 1 3/4 inches). Laparoscopic adrenalectomy is the perfect approach to these masses which would otherwise necessitate numerous repeated CAT scans and often life-long follow-up by a physician.
• Tumors which have NO characteristics of malignancy. Laparoscopic removal of the adrenal gland is not appropriate for any cancerous tumors or those which have clinical / radiologic characteristics of malignancy.