Patient Information
Department of Urology
66/Urol_04_09
Laparoscopic removal of the adrenal gland
Page 1 of 7
Laparoscopic removal of the adrenal gland: procedure-specific information What is the evidence base for this information? This leaflet includes advice from consensus panels, the British Association of Urological Surgeons, the Department of Health and evidence-based sources; it is, therefore, a reflection of best practice in the UK. It is intended to supplement any advice you may already have been given by your GP or other healthcare professionals. Alternative treatments are outlined below and can be discussed in more detail with your Urologist or Specialist Nurse. What does the procedure involve? This involves removal of the adrenal gland through several keyhole incisions. It requires placement of a telescope and operating instruments into your abdominal cavity using 3-4 small incisions. One incision may need to be enlarged to remove the adrenal gland What are the alternatives to this procedure? Observation, open surgery
Laparoscopic removal of the adrenal gland
Page 2 of 7
What should I expect before the procedure? You will usually be admitted on the same day as your surgery. You will normally receive an appointment for pre-assessment, approximately 14 days before your admission, to assess your general fitness, to screen for the carriage of MRSA and to perform some baseline investigations. After admission, you will be seen by members of the medical team which may include the Consultant, Specialist Registrar, House Officer and your named nurse. You will be asked not to eat or drink for 6 hours before surgery and, immediately before the operation, you may be given a pre-medication by the anaesthetist which will make you dry-mouthed and pleasantly sleepy. Please be sure to inform your Urologist in advance of your surgery if you have any of the following:
an artificial heart valve
a coronary artery stent
a heart pacemaker or defibrillator
an artificial joint
an artificial blood vessel graft
a neurosurgical shunt
any other implanted foreign body
a prescription for Warfarin, Aspirin or Clopidogrel (Plavix®)
a previous or current MRSA infection
What happens during the procedure? Normally, a full general anaesthetic will be used and you will be asleep throughout the procedure. In some patients, the anaesthetist may also use an epidural anaesthetic which improves or minimises pain post-operatively. A bladder catheter is normally inserted during the operation to monitor urine output and a drainage tube may be placed through the skin into the bed of the adrenal gland.
Laparoscopic removal of the adrenal gland
Page 3 of 7
What happens immediately after the procedure? You will be given fluids to drink from an early stage after the operation and you will be encouraged to mobilise as soon as you are comfortable to prevent blood clots forming in your legs. The wound drain and catheter are normally removed after 24-48 hours. The average hospital stay is 3-5 days. Are there any side-effects? Most procedures have a potential for side-effects. You should be reassured that, although all these complications are well-recognised, the majority of patients do not suffer any problems after a urological procedure. Please use the check boxes to tick off individual items when you are happy that they have been discussed to your satisfaction: Common (greater than 1 in 10) Temporary shoulder tip pain Temporary abdominal bloating Temporary insertion of a bladder catheter and wound drain Conversion to open surgery or requiring blood transfusion (approximately 14%) Occasional (between 1 in 10 and 1 in 50) Bleeding, infection, pain or hernia of the incision requiring further treatment Rare (less than 1 in 50) Entry into lung cavity requiring insertion of a temporary drain The histological abnormality may eventually turn out not to be cancer Recognised (or unrecognised) injury to organs/blood vessels requiring conversion to open surgery (or deferred open surgery) Involvement or injury to nearby local structures (blood vessels, spleen, liver, kidney ,lung, pancreas, bowel) requiring more extensive surgery Anaesthetic or cardiovascular problems possibly requiring intensive care admission (including chest infection, pulmonary embolus, stroke, deep vein thrombosis, heart attack and death) Hospital-acquired infection (overall risk for Addenbrooke’s) Colonisation with MRSA (0.9%, 1 in 110) Clostridium difficile bowel infection (0.2%; 1 in 500) MRSA bloodstream infection (0.08%; 1 in 1,250) (These rates may be greater in high-risk patients e.g. with long-term drainage tubes, after removal of the bladder for cancer, after previous infections, after prolonged hospitalisation or after multiple admissions)
Laparoscopic removal of the adrenal gland
Page 4 of 7
What should I expect when I get home? There may be some discomfort from the small incisions in your abdomen but this can normally be controlled with simple painkillers. All the wounds are closed with absorbable stitches which do not require removal. It will take 10-14 days to recover fully from the procedure and most people can return to normal activities after 2-4 weeks. When you leave hospital, you will be given a “draft” discharge summary of your admission. This holds important information about your inpatient stay and your operation. If, in the first few weeks after your discharge, you need to call your GP for any reason or to attend another hospital, please take this summary with you to allow the doctors to see details of your treatment. This is particularly important if you need to consult another doctor within a few days of your discharge. What else should I look out for? If you develop a temperature, increased redness, throbbing or drainage at the site of the operation, you should contact your GP immediately. Are there any other important points? A follow-up outpatient appointment will normally be arranged for you 6-12 weeks after the operation. At this time, we will be able to inform you of the results of pathology tests on the removed adrenal gland. It will be at least 14-21 days before the pathology results on the tissue removed are available. It is normal practice for the results of all biopsies to be discussed in detail at a multi-disciplinary meeting before any further treatment decisions are made. You and your GP will be informed of the results after this discussion. Your remaining adrenal gland will serve the full function originally carried out by the pair of glands. It is sometimes necessary, however, to take medications to help the remaining gland recover (usually in patients with Cushing’s syndrome). If both glands have to be removed (this is very rare), medications will need to be taken to replace their function. Is there any research being carried out in this field at Addenbrooke’s Hospital? All laparoscopic procedures are subject to continuous audit by the British Association of Urological Surgeons Section of Endourology. In addition, the National Institute of Health & Clinical Excellence (NICE) requires that we maintain a careful review of laparoscopic procedures.
