The adrenal gland is a triangular organ that sits on top of the kidney on both sides. It contains a cortex-outer layer and medulla-inner layer. These layers arise from different types of cells and therefore the symptoms experienced from tumours arising from these 2 distinct layers are very different. The outer layer produces hormones such as aldosterone and cortisol, which regulate a wide variety of bodily and cellular functions. The inner layer or medulla produces the hormones of “flight or fright” adrenaline and noradrenaline.
Adrenal surgery is required for one of the following situations:
– Functionally overactive tumour producing excess hormones causing
- Conn’s syndrome -retention of salt and water, loss of potassium and high blood pressure.
- Cushing’s syndrome – excess cortisol producing diabetes, hypertension, moon face, thin skin, and weight gain.
- Phaeochromocytoma – excess adrenaline and noradrenaline producing drenching sweats, high blood pressure, a racing heart and severe headaches
– Functionally overactive tumour producing excess hormones that can be measured on blood and urine tests, but without a full blown clinical syndrome
– Functionally inert tumour, but which are of sufficient size or have other characteristics on imaging which make a cancer possible
– For an obvious cancer
The majority of adrenal tumours removed for hyperfunction are done by adrenal surgeons using a keyhole technique. Three to four small 5-10mm cuts are made in the abdomen (laparoscopic approach) or the back (retroperitoneal approach) to insert ports to perform the operation. The advantages of this technique are numerous and include 1-2 night hospital stay, less pain post surgery, earlier return to work and full activities. This is in comparison to the traditional subcostal incision to remove these tumours.
Some tumours, however, are not suitable for the keyhole approach and still require a 10cm or greater incision because of the size of the tumour or a known diagnosis of cancer prior to the operation.
As with any operation, there is a risk of bleeding and infection in adrenal surgery. Rarely, during the keyhole operation, Professor Sidhu may need to convert to an open operation. However, this occurs very rarely in 2-3% of patients. With an open operation, there is an increased risk of hernia formation in the wound.
What time should I go to hospital?
If you are having an operation in the public hospital, the hospital will contact you about 1 month prior to surgery and ask you to attend for a preoperative assessment by the hospital anaesthetic team. The hospital will notify you of the time to arrive on the day of your operation.
In the private hospital setting, your date will be allocated at the time of consultation or soon thereafter and you will be seen by your private anaesthetist prior to or on the day of surgery. The private hospital will notify you, the day prior to surgery, of the time to arrive on the day of your operation.
Do I need to fast?
Yes, you do. Patients having morning surgery need to be fasted from 12 midnight and patients having afternoon surgery are permitted to have a light breakfast and fast from 0700 hours.
All patients taking a tablet that causes bleeding must stop the tablets prior to surgery.
This includes the following medications:
- Aspirin – 2 weeks
- Plavix or Iscover – 2 weeks
- Warfarin – 5 days
- Herbal medications eg St John’s Wort – 2 weeks
- Factor X inhibitor eg Xarelto -3 days
Professor Sidhu will discuss these medications at the time of consultation.
Your adrenal surgery is undertaken using a general anaesthetic – you will be asleep for the operation. A local anaesthetic will be administered to numb the skin for 12-16 hours after surgery. The anaesthetic tube used during the adrenal surgery can sometimes cause a sore throat afterwards. You will be given tablets for pain relief afterwards.
The hospital stay is usually for 1 or 2 nights for a keyhole operation and 5 days for an open operation.
The wound is closed with a dissolving suture and the steristrip dressing stays on for 10 days. You can shower as normal. Following 10 days, the steristrip is replaced with a brown micropore tape. This can be changed every 2 days with the use of BIO Oil in between dressing changes. The use of the steristrip for 6 weeks’ post surgery minimizes scar stretching.
No driving is permitted for 2 weeks following keyhole surgery and several weeks following open surgery. You may return to work within 2 weeks following keyhole surgery depending on the type of work you undertake and following open surgery this may take up to 2 months.
Following discharge, if you develop the following symptoms please contact Professor Sidhu immediately:
- Redness, heat, or discharge from the wound
- A high temperature with night sweats
- Severe shortness of breath and/or chest pain
- Nausea and/or vomiting