The adrenals are glands situated very close to the kidneys and in close contact with large vessels, such as the aorta and the inferior vena cava. They produce hormones (epinephrine, considered as the stress hormone), noradrenaline mineralocorticoids (aldosterone), glucocorticoids (cortisol), and sex steroids.
Adrenal disorders may require surgical removal as they may be quite severe. They include malignant tumors (adrenal carcinoma, metastatic tumors and other organs), hormone producing benign tumors (pheochromocytoma, adenoma), benign adrenal hyperplasia, potentially malignant tumors>4 cm. Adrenaline oversecretion may be a rare cause of hypertension but also a life threatening cause of hypertensive crisis in stressful situations (e.g. another surgical procedure).
Laparoscopic adrenalectomy is the surgical method of choice for removing the diseased adrenal gland. It is a very demanding surgical operation which involves less intraoperative loss of blood, better surgical field, less surgery stress, shorter hospital stay and faster return to daily activity.
This procedure is performed in various ways. The patient is placed in supine position (anterior transperitoneal access), or in lateral position (kidney position – lateral or lumbar method) or is less often accessed from a posterior – retroperitoneal plane. A laparoscopic camera is inserted via a single 1cm incision, after creating a pneumoperitoneum (instilling air within the abdomen).
Smaller 0.5 cm incisions are performed for inserting other surgical apparatus.
This method requires an extensive experience and is technically challenging. Laparoscopic access provides surgeons with better images, thus minimizing loss of blood. The adrenal vessels are ligated and the organ is removed via a small incision, depending on it size (<5cm), after being placed in a specimen retrieval sac. The patient stays in hospital for 1-2 days and their postoperative course is related to less postoperative pain and fewer complications vs open surgery.