Your Adrenal Surgery

Minimally invasive
adrenal surgery

Minimally invasive adrenal surgery is laparoscopic removal of adrenal tumor through the abdominal or back approaches (posterior retroperitoneoscopic adrenalectomy). There will be 3 small incisions instead of one large as it used to be in a past. This technique makes the healing process faster and with minimum scar formation. The best approach for the patients and the most common approach that I am using at this time is Posterior Retroperitoneaoscopic Adrenalectomy (posterior laparoscopic adrenalectomy from the back) - laparoscopic surgery through the back. It is more modern and advanced technique that was developed by Professor Waltz form Germany. It has significant advantage of avoiding entrance into the abdominal cavity and because of that it results in significantly less post -operetive pain, quicker recovery, can be performed on any patients even those who have had multiple abdominal surgeries and developed sever adhesions. The cosmetic result is much better then abdominal approach. Almost each surgeon in United States and all over the world, who is able to perform this technique, had to visit Dr Walz's Hospital in Germany and learn the technique of posterior adrenalectomy from him.

Figure 1: Scar 2 weeks after left laparoscopic adrenalectomy

THE SURGERY PROCESS

Anesthesia

The procedure is done under general anesthesia. Patient's position for Posterior Retroperitoneoscopic Adrenalectomy is prone. Our Anesthesia Team (anesthesiologist and nurse anesthetist) is highly qualified and experienced in providing anesthesia in this specific patient’s position. They are also have a great level of expertise in providing anesthesia to patients with multiple medical co-morbidities and also for providing specific type of anesthesia for patients with hypertension secondary to Pheochromocytoma, Cushing’s syndrome and hyperaldosteronism.

Your Operating Room

All adrenal surgeries, including Posterior Retroperitoneoscopic Adrenalectomy (adrenal laparoscopic surgery from the back), are performed in specially design State-Of-Art Laparoscopic Operating Room. This operating room is equipped with cutting edge laparoscopic equipment and specifically design table allowing for positioning of the patient for this highly sophisticated procedure.

Figure 2: Jersey Shore University Medical Center operating room where I perform all posterior retroperitoneoscopic
adrenalectomy surgeries (laparoscopic adrenal surgery from the back)

Your Surgery

Posterior Retroperitoneoscopic Adrenalectomy (adrenal laparoscopic surgery from the back), is performed in patients position laying prone on a specially designed table.

Figure 3: Patient’s position for posterior retroperitoneoscopic adrenalectomy surgeries
(laparoscopic adrenal surgery from the back)

Length of hospital stay
and Postoperative Care

All patients after adrenal laparoscopic surgery, including Posterior Retroperitoneoscopic Adrenalectomy, will stay in recovery room for 30 min to an hour and then will be staying on the floor for 23 hours (overnight stay only) in specially design, state-of-art, patients’ room with flat screen TV. The room is equipped with Cutting Edge sophisticated equipment, Private Bath with ADA Compliant Roll-In Shower, and Corian Sink. Each room has an additional couch for your accompany person to rest. Concierge Service is available.

Figure 4: Jersey Shore University Medical Center, patients’ room for postoperative stay (North–West Pavilion)
after posterior retroperitoneoscopic adrenalectomy surgeries (laparoscopic adrenal surgery from the back)

Pain

Postoperatively most of the patients have little pain which is easily controlled with postoperative pain medications or injections. It is especially true for posterior retroperitoneoscopic adrenalectomy. With this approach patient is almost pain free the day of the surgery and majority of the patients are only taken one pain pill that day and return to their normal routine the day after the surgery.

Drain: there will be no drains.

Stitches and Scars

The surgery performed through 3-4 small incisions, the stitches will be small, subcutaneous which dissolves on its own and do not required removal. Either skin glue or Steri-strips will be applied and will stay for about a week. They will be peel off on its own. Because the incisions will be small and the stitch will be subcutaneous the size of the scar will be much less than that with traditional open surgeries performed in the past.

However the scaring tendency is dependent on the individual skin healing proprieties. The surgeon will make all efforts to have best cosmetic result possible.

COMPLICATIONS

Bleeding

With current technique the incidence of bleeding is minimal.

Wound infection

With current technique the incidence of wound infection is minimal.

POSTOPERATIVE CARE

Incision site

Skin glue will stay for about 10 days and will come off by itself. The Steri-strips will peel off on its own in 6-8 days. After that you can apply moisturizer to the wound, use Mederma or lotion with Vitamin E.

Physical restrictions

There will be limited physical restrictions for about 2 – 4 weeks after the surgery. Most of the patients resume their normal physical activities within several days after the surgery, especially those who have had posterior approach.

Shower

You can take shower in 48 hours (2 days) after the surgery. Do not scratch or peel off the Steri-strips or glue, just wipe it with the towel.

Pathology report

Usually available within 5-7 days after the surgery.

Problem calls

Please immediately call doctor if you develop significant pain, abdominal swelling fever or chills, or your incisions become very red after the surgery. We are available 24 hours a day, 7 days a week, on call on our cell phones.

Postoperative visit

2-3 weeks after the surgery: for wound check and pathology report.

Posterior retroperitoneaoscopic
adrenalectomy

Figure 5: Incision covered with skin glue, immediately after the removal of the large (5 cm = 2 inch) right adrenal tumor
by posterior retroperitoneoscopic adrenalectomy (laparoscopic adrenal surgery from the back)

Figure 6: Scars, 4 weeks after posterior retroperitoneoscopic adrenalectomy (laparoscopic adrenal surgery from the back)

Figure 7: Large (5 cm = 2 inch) right adrenal tumor removed from the patient above by posterior retroperitoneoscopic
adrenalectomy (laparoscopic adrenal surgery from the back)

Figure 8: Scars, 2 weeks after the removal of the left adrenal tumor by posterior retroperitoneoscopic adrenalectomy
(laparoscopic adrenal surgery from the back)

Figure 9: Left adrenal tumor removed from the patient pictured above by posterior retroperitoneoscopic adrenalectomy
(laparoscopic adrenal surgery from the back)