The Laparascopic Right Adrenalectomy Technique

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The Adrenal Glands

The adrenal glands are paired organs located right above each the renal glands, the kidneys. These glands are small and round and belong to the endocrine system. They produce hormones that affect the person’s stress response, metabolism, kidney function, and the production of urine.

The adrenal gland will secrete its hormones into the bloodstream to act on other organs. These organs have three major vessels heavily supplying them with blood: the phrenic artery, aorta, and renal artery. The glands are split into a cortex and a medulla.

Inside the medulla, the hormones adrenaline and noradrenaline are produced. These hormones are secreted to when the body would like to increase the heart rate or pump more blood to the organs.

Inside the cortex, the corticoid hormones are secreted. These hormones are responsible for the body’s metabolism. The cortex also secretes the sex hormones androgens, and the hormone aldosterone. Aldosterone is needed to act on the kidneys regulate the water and salt concentrations in the urine.

As the adrenal glands produce many different types of hormones, an overactive adrenal gland can produce quite a number of symptoms and changes within the body.

Why Is The Procedure Completed?

The right adrenalectomy technique is a method in which the right adrenal gland is removed. It is usually done in a process called laparoscopic surgery. This type of surgery does not involve opening the entire abdomen to remove the adrenal gland, but instead a camera and surgical laparoscope is inserted through a small cut to remove the gland.

This technique is performed when there is an overactive gland on the right side. This gland can be producing excess of epinephrine from the adrenal medulla leading to a condition known as Graves disease. Graves disease is quite serious as the signs of the disease involve an increased heart rate and blood pressure, anxiety, and the inability to concentrate.

Another reason in which the right adrenal gland can be removed is due to an increase in aldosterone hormone being produced. This condition is known as aldosteronism. The body retains salt leading to an increased blood pressure. There are also problems with muscle weakness and cramps. The person will also have a low potassium level.

A third reason why the right adrenal gland is removed is due to a tumor. A tumor within the adrenal medulla is known as a pheochromocytoma, whereas a tumor in the adrenal cortex is known as Conn’s syndrome. The tumor cells will create overactive gland function and excesses of the hormones previously discussed.

Complications Of The Procedure

The main complication with this right adrenalectomy technique has to due with the blood supply. Other than the thyroid gland, no other organ is so heavily supplied with blood from three major arteries. This can be a concern when the procedure is being completed, as to ensure that hemorrhaging does not occur.

However the veins that drain the right adrenal gland have the potential for most complication as the right adrenal vein is directly connected to the inferior vena cava. In some people, only on the right side a second vein called an accessory vein might be present. This would drain into the hepatic vein. Therefore, when this accessory vein occurs, some surgeons elect not to do laparoscopy and instead complete only a partial removal of the gland.

The Patient’s Followup Care

The followup care after this procedure will be to avoid the person becoming infected at the surgical wound site. This can be done with proper wound care. As only the right adrenal gland is removed, the patient’s hormones and test values are expected to return to normal. If the left adrenal gland was removed previously, then hormone replacement therapy will be needed.

References

Web Source: WebSurg World Virtual University. “Laparoscopic Right Adrenalectomy” 2001. Available: https://www.websurg.com/ref/Laparoscopic_right_adrenalectomy-ot02en211.htm

Web Source: Society of American Gastrointestinal Endoscopic Surgeons (SAGES). “Laparoscopic Adrenal Gland Removal”. 2004 Available:https://www.sages.org/publication/id/PI14/