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Sample Consultation for Laparoscopic Adrenalectomy

This hypothetical consultation about laparoscopic adrenalectomy for adrenal gland ademoma is presented for purposes of general information. If you think you may have this condition, please see your doctor to discuss your individual case and the exams and treatments that are best for you.

Background 

There are multiple reasons for an individual to need his or her adrenal gland removed. Some of the more common conditions requiring removal of the adrenal glands are adrenal mass (incidental adenoma), pheochromocytoma, aldosteronoma (Conn’s syndrome), and Cushing’s syndrome.

Occasionally masses are found in the adrenal glands when a patient has a CAT or MRI scan for another medical condition. In our example, a CT scan for kidney stones showed that the patient has an adrenal mass. Most patients do not have any symptoms related to these incidentally-discovered masses. Smaller masses are usually adenomas, meaning that they are benign, or harmless. If the mass is above a certain size, there is some risk that the mass is malignant (cancerous). Depending on the patient’s individual case, the doctor may recommend removing the affected adrenal gland to be sure that the mass is not a cancer.

Consultation

Doctor: Hello. How are you today?

Patient: I’m fine, thank you.

Doctor: What brings you here today?

Patient: My doctor referred me to you to talk about removing one of my adrenal glands. He found a tumor when I had an x-ray for a kidney problem.

Doctor: Yes, I see from your x-ray report that there is a small adenoma, something we call an incidental adenoma, on the right adrenal gland. Do you understand why your primary care doctor has referred you to me to talk about removing your adrenal gland?

Patient: Not very clearly.

Doctor: All right. As you may know, everyone has two adrenal glands, one on each side of the body. The adrenal glands are located on the top of each kidney. And they are normally quite small. They produce and excrete hormones that help your body function normally and respond appropriately to stress. Some of these hormones are cortisol, aldosterone and epinephrine, which is also called adrenaline.

The most common reason for removing an adrenal gland is the condition that you have, which is a small growth on the gland which is most likely benign. You are not having any symptoms right now, and the mass would not have been detected unless you had an x-ray for another reason. Because of that, we call these “incidental adenomas.”

Patient: And it has to be removed?

Doctor: When incidental adenomas reach a certain size, they become more worrisome for two reasons. First, the adenoma may start to function like adrenal gland tissue and produce too much hormone. Second, the adenoma may become malignant. In cases like this, we remove the gland to be sure that the growth is benign and to prevent any future problems that might occur if the mass grew, or if it began to produce hormones that could cause you to have a hormonal imbalance or problems.

Patient: What if I do not have the surgery?

Doctor: There is the risk that the mass could start to produce hormones, which might cause you to have high blood pressure, weight gain or electrolyte imbalances, all of which can be serious. In your case, I recommend that we remove the adrenal gland so that you do not suffer any of these possible effects in the future.

The doctor takes the patient’s medical history and performs a physical examination.

Patient: What is the surgical procedure?

Doctor: The surgery is called a laparoscopic adrenalectomy. A laparoscopic, or minimally invasive, surgery involves specialized video equipment and instruments that allow me to remove your adrenal gland through very small incisions.

Patient: How many incisions?

Doctor: Usually 4 or 5 very small incisions are all that is required to remove your adrenal gland laparoscopically.

Patient: Will you take out the entire gland, or only part of it?

Doctor: The gland is removed in its entirety. You have another adrenal gland on the other side that can take over the function of both glands.

Patient: What are the advantages of laparoscopic surgery?

Doctor: The benefits of this minimally invasive approach include less pain, faster recovery, less scarring, and earlier return to normal activities.

Patient: Will I need to stay overnight in the hospital?

Doctor: Yes, most patients stay one night in the hospital and go home the next day.

Patient: What complications are there?

Doctor: With any operation there are potential risks. You will have general anesthesia, and any time a patient undergoes an anesthetic, there is a chance that you will have a reaction to the anesthesia or that you will have trouble breathing, abnormal rhythms of the heart, or a heart attack. These complications are rare and you need to discuss them with the anesthesiologist. In addition, there are risks specifically for this surgery.

Patient: What are those risks?

Doctor: The specific risks for this surgery are bleeding, infection, injury to the bowel, major vessels, or other organs, stroke, high blood pressure, injury to surrounding organs, and cardiopulmonary complications. During the course of the operation, if we determine that it is not safe to proceed with the procedure laparoscopically, then we may change the operation to an open or traditional incision, which is larger than the laparoscopic incisions. Again, we make that decision for your safety.

Patient: Okay. How do I prepare for the surgery?

Doctor: You should continue to take your blood pressure medication up until the time of your operation, even the morning of your surgery. We instruct you not to eat or drink anything after midnight the night before your surgery, but you can take your medications with a sip of water on the morning of the surgery.

Patient: How long does the surgery take?

Doctor: It can take anywhere from two to three hours.

Patient: How will I feel after the surgery?

Doctor: Most patients feel groggy or sleepy after the procedure. You may not remember much about the day because of the medications that are given to you during the operation. You will wake up in the recovery room, where you will stay for several hours and then go to your hospital room. Your family and friends will be able to visit you once you have moved to your room.

Patient: Will I have much pain?

Doctor: Usually there is mild discomfort after the surgery, and we will give you medications for it.

Patient: How soon will I get back to normal?

Doctor: You may feel very tired, sore, and nauseated for the first day or two after the surgery, but you will probably be able to take clear liquids the day after surgery and you will be able to get out of bed and walk. After that, you should be able to get back to your normal activities, including work, in about a week. You should avoid any heavy lifting for 8 weeks after the surgery.

Patient: When will I come back to see you after the surgery?

Doctor: I would like to see you here in the clinic two weeks after your surgery.

Patient: I think I would like to go ahead with the surgery. What is the next step?

Doctor: I will order some preoperative blood and urine tests now, and my assistant will contact you to schedule the procedure. Do you have any other questions?

Patient: Just one. Will I have any problems because I have only one adrenal gland?

Doctor: No. You can survive quite normally with only one adrenal gland.

Patient: All right. Thank you, doctor.