Laparoscopic and open adrenalectomy are surgical procedures to remove one or both adrenal glands. Laparoscopic adrenalectomy is preferred for benign tumors. Open adrenalectomy is used for large tumors or suspected cancer. The adrenal glands are located near the kidneys and removal involves carefully dissecting and ligating the adrenal vein. Potential complications include insufficient hormone production, bleeding, infections, and injury to nearby organs. Adrenalectomy is usually performed for conditions like Conn syndrome, Cushing syndrome, pheochromocytoma, adrenocortical carcinoma, or neuroblastoma.

1. ADRENALECTOMY
Dr. SUBBAIAH. M.P.T

2. ADRENALECTOMY
• DISORDERSS OF ADRENAL GLAND

3. ANATOMY
 Weight = 4g
 2 adrenal gland,
right and left
 2 component ; inner
adrenal medulla and
outer adrenal cortex
 Situated near upper
poles of kidneys in
retro peritoneum,
within Gerota’s
capsule

4. ANATOMY CON’T
 Right adrenal
gland
– between
right liver
lobe and
diaphragm
 Left adrenal gland
– close to upper
pole of left kidney
and renal pedicle,
covered by
pancreatic tail and
spleen

5. ANATOMY CON’T
 Arterial blood suppl
–superior suprarenal
artery (from inferior
phrenic artery)
-middle suprarenal
artery (from abdomin
aorta)
- inferior suprarenal
artery (from renal
artery)

6. DEFINITION
 Adrenalectomy is the surgical removal of
one or both (bilateraladrenalectomy) adrenal
glands.
• It is usually advised for patients with tumors
of the adrenal glands.
• The procedure can be performed using an
open incision (laparotomy)
or laparoscopic technique.

7. INDICATIONS
• Conn syndrome.
• Cushing syndrome.
• Pheochromocytoma.
• Large myelolipoma.
• Metastatic tumors.
• Adrenocortical carcinoma.
• Neuroblastoma (pediatric population)

8. 1. Conn syndrome
• Primary aldosteronism, also
known as primary
hyperaldosteronism or Co
nn's syndrome, is excess
production of the hormone
aldosterone by the adrenal
glands resulting in low renin
levels.
• Often it produces
few symptoms. Most
people have high blood
pressure which may cause
poor vision or headaches.

9. 2. CUSHING’S SYNDROME
• Cushing's syndrome is
caused by either
excessive cortisol-like
medication such as
prednisone or a tumor
that either produces or
results in the
production of excessive
cortisol by the adrenal
glands.

10. 3.PHEOCHROMOCYTOMA
• Pheochromocytoma is
a rare tumor of adrenal
gland tissue.
• It results in the release
of too much
epinephrine and
norepinephrine,
hormones that control
heart rate, metabolism,
and blood pressure.

11. 4. LARGE MYELOLIPOMA
• Myelolipoma (myelo-,
from the ancient greek
marrow;
lipo, meaning of, or
pertaining to, fat; -
oma meaning tumor or
mass) is a benign
tumor-like lesion
composed of mature
adipose (fat) tissue and
haematopoietic (blood-
forming) elements in

12. 4. METASTASTIC TUMORS
• Metastasis is the
spread of cancer cells to
new areas of the body
(often by way of the
lymph system or
bloodstream).
• A metastatic cancer,
or metastatic tumor, is
one which has spread
from the primary site of
origin (where it started)
into different area(s) of

13. 5. ADRENO CORTICAL
CARCINOMA
• Adrenocortical
carcinoma is a rare
disease in which
malignant (cancer) cells
form in the outer layer
of theadrenal gland.
• There are
two adrenal glands.
Theadrenal glands are
small and shaped like a
triangle.
One adrenal gland sits

14. 6. NEUROBLASTOMA
• Neuroblastoma (NB) is
a type of cancer that
forms in certain types of
nerve tissue. It most
frequently starts from
one of the adrenal
glands, but can also
develop in the neck,
chest, abdomen, or
spine. ..

15. PRIMARY
HYPERALDOSTERONISM (PHA)
 Hypertension , Hypokalemia,
Hypersecretion
• of aldosterone
 Hypertensive patient with hypokalaemic
PHA~
• 2%
 Hypertensive
patie potassium :
12%

16. SURGERY OF THE ADRENAL
GLANDS
 LAPAROSCOPIC ADRENALECTOMY:
 RIGHT ADRENALECTOMY
 LEFT ADRENALECTOMY
 RETROPERITONEOSCOPIC
 ADRENALECTOMY
 OPEN ADRENALECTOMY

17. TYPES OF ADRENALECTOMY
The two types of adrenalectomy
1. Open adrenalectomy
2. Laparoscopic adrenalectomy

18. OPEN ADRENALECTOMY
 An open adrenalectomy is often required
when either the adrenal glands or the
tumors are abnormally large.
In this procedure a single incision is made
either in the abdominal wall just under
the ribcage, or the back or sides.

19. OPEN ADRENALECTOMY
 Malignant adrenal tumour suspected
 Rt side: hepatic flexure of the colon is
mobilised & the rt liver lobe is cranially
retracted to achieve an optimal
exposure of the IVC & the adrenal gland
 Lf side: AG can be exposed after
mobilisation of the splenic flexure of the
colon,through the transverse mesocolon/
the gastrocolic ligament
 Resection of regional lymph node is
recommended and should include
resection of the tissue between the renal

20. LAPROSCOPIC ADRENALECTOMY
Laparoscopic adrenalectomy is the procedure
of choice for benign (non-cancerous) adrenal
tumors.
 Laparoscopic surgery has proved to be a
major advancement for the management of
adrenal tumors.

21. RIGHT ADRENALECTOMY
 Position: right side up,with table brake
 Dissection start at the level of the periadrenal
fat
 Peritoneum is divided 2cm below the edge of
liver
• from medial(IVC) to the lateral abdominal wall
 Flap of peritoneum can be used to retract the
liver up & off the adrenal
 Identify the gland and mobilise gently,
securing the vein with a clip/using one of
the available energy device

22. RIGHT ADRENALECTOMY
LAPROSCOPIC PROCEDURE

23. LEFT ADRENALECTOMY
 Position: right side
 Mobilisation of the spleen will displace
the pancreatic tail medially
 Incison of Gerota’s fascia is followed by
• identification of the adrenal vein
 The resection is completed by mobilising the
• adrenal gland at the level of the periadrenal
fat
 Remove the gland in a bag

24. LEFT ADRENALECTOMY LAPROSCOPIC
PROCEDURE

25. RETROPERITONEOSCOPIC
ADRENALECTOMY
 1ST port: distal end of the 12th rib(prone
• position)
 Digital dissection into the retroperitoneum,
• Gerota’s fascia is displaced ventrally
 RAV is covered by the retrocaval posterior
aspect of the adrenal gland
 LAV is located at the medial inferior pole of the
• adrenal gland
 High inflation pressures allow bloodless
• dissection effectively tamponading the veins

27. COMPLICATIONS
• Insufficient cortisol production.
• Decreases in blood pressure.
• Bleeding.
• Infections in the wound, urinary tract, or
lungs.
• Blood clots in the legs.
• Injury to nearby organs or structures.
• Adverse reaction to anesthesia.