Progress of the operation
The approach is selected according to the side and size of the tumor: transperitoneal lateral (the patient is on the side, the liver or spleen is retracted) or retroperitoneoscopic (through the lower back, without entering the abdominal cavity). The adrenal gland is carefully isolated without compressing the tumor - in case of pheochromocytoma, the central vein is crossed first to stop the release of catecholamines; the anesthesiologist controls the pressure. The gland is removed in a container and sent for histology. The drainage is removed the next day. After removal of the corticosteroma, temporary replacement therapy with hydrocortisone is prescribed under the supervision of an endocrinologist.
Indications for adrenalectomy
- hormonally active tumors: pheochromocytoma, aldosteroma (Conn's syndrome), corticosteroma (Cushing's syndrome), androgen- and estrogen-producing;
- tumors larger than 4–6 cm or growing during observation (risk of adrenocortical cancer);
- suspicion of a malignant tumor on CT/MRI;
- metastases to the adrenal gland with a controlled primary tumor;
- bilateral hyperplasia in Cushing's disease, unresponsive to other treatment.
Laparoscopy - standard
Laparoscopic adrenalectomy replaced open adrenalectomy for tumors up to 8–10 cm: 3–4 punctures, minimal blood loss, hospital stay 3–5 days. For pheochromocytoma, surgery requires coordinated work of the anesthesiologist (pressure fluctuations during manipulation of the tumor) and preliminary preparation with alpha blockers. Open access remains for large invasive tumors suspected of being cancerous. After removal of a hormonally active tumor, blood pressure and metabolic disorders normalize in most patients.
