What Is a Laparoscopic Adrenalectomy?

In 1901, German surgeon Kelling first used the Nize cystoscope for laparoscopy. With the improvement and development of endoscope, laparoscopy has been widely used in the diagnosis and treatment of general surgery, obstetrics and gynecology and urology. It has the advantages of less damage, less postoperative pain, and faster recovery. It is increasingly accepted and applied by patients and urologists.

Basic Information

Chinese name: Laparoscopic surgery for adrenal diseases
Related diseases: Aldosterone tumor, Cushing syndrome, etc.
Specialty classification: Urology

Indication: Aldosterone tumor, Cushing syndrome, etc.
Contraindications: Systemic bleeding disorders, acute abdominal inflammation, etc.
Postoperative complications: Subcutaneous emphysema, tension pneumoperitoneum, arrhythmia

Laparoscopic anesthesia for adrenal diseases and preoperative preparation

Anesthesia mode

Epidural anesthesia plus endotracheal intubation.

2. Preoperative preparation

(1) Preoperative preparation for hypercortisolism

1) Cortisone acetate is usually injected intravenously 12 hours and 24 hours before surgery.

2) Patients who are hyperglycemic and urine glucose positive should control their blood glucose and urine glucose to normal ranges.

3) ACTH was injected intramuscularly 2 days before the operation of cortical adenoma.

4) Correct water and electrolyte balance disorders.

5) Apply broad-spectrum antibiotics before surgery.

6) Correct the negative nitrogen balance.

(2) Preoperative preparation for primary aldosteronism

1) Limit sodium and potassium.

2) Blood potassium is normal, nocturnal urine volume is normal or almost normal, and urine potassium is less than 20mmol / L, and surgery is feasible.

3) Improve heart function.

4) Give effective antibiotics 2 to 3 days before surgery.

(3) Preoperative preparation of adrenal pheochromocytoma and adrenal medulla

1) Use alpha-blocker benzylamine. Use nifedipine, a calcium channel blocker.

2) Volume expansion therapy

3) The scopolamine is used as anesthetic before surgery.

4) Corticosteroid reserve.

5) Antibiotics are routinely applied before surgery to eliminate infections in the body.

Laparoscopic indications for adrenal disease

1. Aldosterone tumor.

2. Cushing syndrome.

3. Adrenal cyst resection.

4. Non-functional sporadic tumors and myeloid lipomas.

5. Adrenal pheochromocytoma.

Contraindications for laparoscopic surgery for adrenal diseases

1. Systemic bleeding disorders.

2. Patients with acute abdominal inflammation.

3. Systemic conditions are difficult to tolerate surgery.

4. Poor lung function.

5. Too obese makes surgery difficult, beginners should not choose.

6. Malignant, multiple, ectopic, and pheochromocytoma with a diameter> 6cm should not be treated with laparoscopy.

Laparoscopic Surgery Procedures for Adrenal Diseases

Transabdominal route

The general steps of the surgery:

(1) Establish artificial pneumoperitoneum.

(2) Put in a laparoscope, connect the pneumoperitoneum, and observe the abdominal organs for damage or bleeding.

(3) Under laparoscopy, make a small incision at the midpoint of the connection between the umbilical cord and the xiphoid process toward the anterior axillary side of the affected side, and place a second trocar.
(4) Due to the body position, the intestinal canal sinks downward, and the colonic liver curvature or colonic spleen curvature can be seen, and the peritoneum enters the right or left retroperitoneal space after incision there.

Left adrenalectomy

The general steps of the surgery:

(1) The posterior peritoneum is cut along the lateral side of the descending colon.

(2) Cut the perirenal fascia, separate it to the renal hilum along the front surface of the left kidney, and expose and free the left renal vein.

(3) Find the left central adrenal vein along the upper edge of the left renal vein. Cut off the left central adrenal vein.

(4) Find the upper, middle and lower adrenal arteries, cut them with titanium clamps, or cut them while electrocoagulation while free. (5) Examine the adrenal gland fossa and completely electrocoagulate to stop bleeding.

Right adrenalectomy

The general steps of the surgery:

(1) Cut the posterior peritoneum along the right side of the ascending colon.

(2) Cut the perirenal fascia, carefully free the anterior and lateral sides of the vena cava at the upper edge of the renal hilum.

(3) Dissect and free the adrenal, middle and inferior adrenal arteries, cut with titanium clamps, or cut with the ultrasonic knife while free.

(4) Thoroughly examine the adrenal fossa and stop bleeding, put the gland into the bag and remove it from the umbilical channel.

(5) Remove the cannula and suture the incision.

2. The retroperitoneal route

The general steps of the surgery:

(1) Make a transverse incision at the mid-axillary line.

(2) Connect the pneumoperitoneum and inject CO2 gas.

(3) Put the water balloon catheter into the trocar and inject 500 ~ 700ml of water.

(4) Place a speculum at the mid-axillary line, place the electrocoagulation hook and scissors in the right-hand channel, and place the separation forceps and suction rod in the left-hand channel.

(5) Observe the posterior peritoneal space, cut open the tensioned fascia, push away the fat tissue, identify the psoas muscle margin, and free it to the head and side, and open the renal fascia and adipose tissue from the rear side. The remaining steps are the same as the intraperitoneal route.

Postoperative complications of laparoscopic surgery for adrenal diseases

Subcutaneous emphysema, tension pneumoperitoneum, chronic arrhythmia, gas embolism, vascular injury, abdominal organ damage, intestinal burns, hernia, urinary injury, infection, deep vein thrombosis, postoperative bleeding.

Nursing for adrenal diseases after laparoscopic surgery

1. Cortisolism

The dosage and time of corticosteroids often depend on the amount of hormones secreted by the adenoma before surgery, the length of the disease course, and the function of the contralateral adrenal gland.

2. Primary aldosteronism

(1) Closely observe the condition.

(2) Hormone supplementation.

(3) Correct water and electrolyte balance.

(4) Management of hypertension.

3. Pheochromocytoma and adrenal medullary hyperplasia

(1) Closely observe the condition and monitor in the ICU after the blood pressure is stable.

(2) When moving in position, pay close attention to the sudden occurrence of circulatory failure and prepare necessary rescue drugs.

(3) Adrenal medullary hyperplasia, bilateral subtotal or total resection of the adrenal gland is performed, and corticosteroids can be added after surgery. For specific methods, see Cortisol hyperplasia. Patients with pheochromocytoma undergoing unilateral surgery do not require corticosteroid supplementation.

(4) Routine application of antibiotics to prevent infection.

(5) Pay attention to changes in electrolytes, regularly measure blood pressure and VMA, and routinely give low-flow oxygen for a few days after surgery.