Laparoscopic Adrenalectomy Print This Page
Laparoscopic Adrenalectomy provides
patients with a safe and effective way to remove a diseased or cancerous
adrenal gland. There are benign as well as malignant forms of adrenal
tumors. Many of the benign adrenal tumors secrete hormones such
as cortisol, aldosterone, epinephrine, norepinephrine and can result
in high blood pressure, facial flushing, weight gain, headaches,
palpitations as well as other symptoms. Adrenal cancer, although
rare, can grow to a large size. Most benign and malignant adrenal
tumors can be removed laparoscopically.
Laparoscopic adrenalectomy is a minimally invasive technique, which
provides patients with less discomfort and equivalent results when
compared to the larger incision required with traditional open surgery.
When compared to conventional open surgery, laparoscopic adrenalectomy
has resulted in significantly less post-operative pain, a shorter
hospital stay, earlier return to work and daily activities, a more
favorable cosmetic result and outcomes identical to that of open
To make an appointment for consultation please call 410-955-6100.
In the event of an emergency and you need to contact someone in the evening hours
or on the week end, please call the paging operator at 410-955-6070 (for
Johns Hopkins Hospital Patients) or 410-550-0100 (for
Johns Hopkins Bayview Medical Center Patients) and ask to speak to the urologist
For directions to Johns Hopkins Hospital please click here
Prior To The Surgery
What to expect during
you preoperative consultation
During your initial consultation with your
surgeon, he will review your medical history as well as any
outside reports, records, and outside Xray films (e.g. CT
scan, MRI, sonogram). A brief physical examination will also
be performed at the time of your visit. If your surgeon determines
that you are a candidate for surgery, you will then meet with
a Patient Service Surgery Coordinator to arrange for the date
of your operation.
NOTE: It is very important that you gather
and bring all of your Xray films and reports to your initial
consultation with your surgeon.
to expect prior to the surgery
Since insurance companies will not permit patients to be admitted
to the hospital the day before surgery to have tests completed,
you must make an appointment to have pre-operative testing
done at your family doctor or primary care physician's office
within 1 month prior to the date of surgery.
These results need to be faxed by your doctor's office
to the Pre-operative Evaluation Center at 443-287-9358 two weeks prior to your surgery. Please call The Documentation
Center at 410-955-9453 two weeks before your surgery date to confirm that this information
Once your surgical date is secured,
you will receive a form along with a letter of explanation
to take to your primary care physician or family doctor in
order to have the following pre-operative testing done prior
to your surgery.
- Physical exam
- EKG (electrocardiogram)
- CBC (complete blood count)
- PT / PTT (blood coagulation profile)
- Comprehensive Metabolic Panel
(blood chemistry profile)
Medications to Avoid Prior to Surgery
Aspirin, Motrin, Ibuprofen, Advil, Alka Seltzer, Vitamin E,
Ticlid, Coumadin, Lovenox, Celebrex, Voltaren, Vioxx, Plavix
and some other arthritis medications can cause bleeding and
should be avoided 1 week prior to the date of surgery (Please
contact your surgeon’s office if you are unsure about
which medications to stop prior to surgery. Do not stop any
medication without contacting the prescribing doctor to get
Bowel Preparation and Clear Liquid Diet
Do not eat or drink anything after midnight
the night before the surgery and drink one bottle of Magnesium
Citrate (can be purchased at your local pharmacy) the evening
before your surgery.
Drink only clear fluids for a 24-hour period prior to the
date of your surgery. Clear liquids are liquids that you are
able to see through. Please follow the diet below.
Clear Liquid Diet
Remember not to eat or drink anything after midnight the evening
before your surgery.
Clear liquids are liquids that you are able to see through.
Please follow the diet below.
- Clear Broths (no cream soups,
meat, noodles etc.)
o Chicken broth
o Beef broth
- Juices (no orange juice or tomato
- Apple juice or apple cider
- Grape juice
- Cranberry juice
- Hawaiian punch
- Kool Aid
- Tea (you may add sweetener, but
no cream or milk)
- Coffee (you may add sweetener,
but no cream or milk)
- Clear Jello (without fruit)
- Popsicles (without fruit or cream)
- Italian ices or snowball (no marshmallow)
Laparoscopic adrenalectomy is performed
under a general anesthetic. The typical length of the operation
is 3-4 hours. The surgery is performed through 3 small (1cm)
incisions made in the abdomen. A telescope and small instruments
are inserted into the abdomen through these keyhole incisions,
which allow the surgeon to completely free and dissect the
diseased adrenal gland without having to place his hands into
the abdomen.The adrenal gland is then placed within a plastic
sack and removed intact through an extension of one of the
existing incision sites.
Potential Risks and Complications
Although this procedure has proven to be very safe, as in
any surgical procedure there are risks and potential complications.
The safety and complication rates are similar when compared
to the open surgery. Potential risks include:
- Bleeding: Blood loss during this
procedure is typically minor (less than 100 cc) and a blood
transfusion is needed in less than 5% of patients. If you
are interested in autologous blood transfusion (donating
your own blood) prior to your surgery, you must make your
surgeon aware. When the packet of information is mailed
or given to you regarding your surgery, you will receive
an authorization form for you to take to the Red Cross in
- Infection: All patients are treated
with intravenous antibiotics, prior to starting surgery
to decrease the chance of infection from occurring after
surgery. If you develop any signs or symptoms of infection
after the surgery (fever, drainage from your incisions,
urinary frequency/discomfort, pain or anything that you
may be concerned about) please contact us at once.
- Tissue / Organ Injury: Although uncommon,
possible injury to surrounding tissue and organs including
bowel, vascular structures, spleen, liver, pancreas, kidney
and gallbladder could require further surgery. Injury could
occur to nerves or muscles related to positioning.
- Hernia: Hernias at incision sites rarely
occur since all keyhole incisions are closed carefully at
the completion of your surgery.
- Conversion to Open Surgery: The
surgical procedure may require conversion to the standard
open operation if difficulty is encountered during the laparoscopic
procedure. This could result in a larger standard open incision
and possibly a longer recuperation period.
What To Expect After Surgery
During your hospitalization
Immediately after the surgery you will
be taken to the recovery room, then transferred to your hospital
room once you are fully awake and your vital signs are stable.
- Postoperative Pain: Pain medication
can be controlled and delivered by the patient via an intravenous
catheter or by injection (pain shot) administered by the
nursing staff. You may experience some minor transient shoulder
pain (1-2 days) related to the carbon dioxide gas used to
inflate your abdomen during the laparoscopic surgery.
- Nausea: You may experience some nausea
related to the anesthesia. Medication is available to treat
- Urinary Catheter: You can expect to have
a urinary catheter draining your bladder (which is placed
in the operating room while the patient is asleep) for approximately
one day after the surgery. It is not uncommon to have blood-tinged
urine for a few days after your surgery.
- Diet: You can expect to have an intravenous
catheter (IV) in for 1-2 days. (An IV is a small tube placed
into your vein so that you can receive necessary fluids
and stay well hydrated; in addition it provides a way to
receive medication.) Most patients are able to tolerate
ice chips and small sips of liquids the day of the surgery
and regular food the next day. Once on a regular diet, pain
medication will be taken by mouth instead of by IV or shot.
- Fatigue: Fatigue is common and should
start to subside in a few weeks following surgery.
- Incentive Spirometry: You will be expected
to do some very simple breathing exercises to help prevent
respiratory infections through using an incentive spirometry
device (these exercises will be explained to you by the
nursing staff during your hospital stay). Coughing and deep
breathing is an important part of your recuperation and
helps prevent pneumonia and other pulmonary complications.
- Ambulation: On the day of surgery it
is very important to get out of bed and begin walking with
the supervision of your nurse or family member to help prevent
blood clots from forming in your legs. You can also expect
to have SCD's (sequential compression devices) along with
tight white stockings to prevent blood clots from forming
in your legs.
- Hospital Stay: The length of hospital
stay for most patients is approximately 1-2 days.
- Constipation/Gas Cramps: You may
experience sluggish bowels for several days following surgery
as a result of the anesthesia. Suppositories and stool softeners
are usually given to help with this problem. Taking a teaspoon
of mineral oil daily at home will also help to prevent constipation.
Narcotic pain medication can also cause constipation and
therefore patients are encouraged to discontinue any narcotic
pain medication as soon after surgery as tolerated.
What to expect after discharge
from the hospital
- Pain control: You can expect to have
some pain that may require pain medication for up to a week
after discharge, and then Tylenol should be sufficient to
control your pain.
- Showering: You may shower after returning
home from the hospital. Your wound sites can get wet, but
must be padded dry immediately after showering. Tub baths
are not recommended in the first 2 weeks after surgery as
this will soak your incisions and increase the risk of infection.
You will have adhesive strips across your incisions. They
will fall off in approximately 5-7 days on their own. Sutures
underneath the skin will dissolve in 4-6 weeks.
- Activity: Taking walks are advised.
Prolonged sitting or lying in bed should be avoided. Climbing
stairs is possible, but should be taken slowly. Driving
should be avoided for at least 1-2 weeks after surgery.
Absolutely no heavy lifting (greater than 20 pounds) or
exercising (jogging, swimming, treadmill, biking) until
instructed by your doctor. Most patients return to full
activity on an average of 3 weeks after surgery. You can
expect to return to work in approximately 2-4 weeks.
- Follow up appointment: You will need
to call the Johns Hopkins Out Patient Urology Clinic at
410-955-6707 after your surgery date to schedule a follow
up appointment as instructed by your surgeon...
- Stent follow up: The stent will remain
in place for approximately one month and will then be removed
in the doctor's office through a cystoscope (a small telescoped
passed down the urethra to retrieve the stent). It is not
uncommon to feel a slight amount of flank fullness and urgency
to void, which is caused by the stent. These symptoms often
improve over time.