Robotic adrenalectomy

What the adrenal gland is

You have two adrenal glands, one on top of each kidney. They are small, triangle-shaped glands. They make several important hormones, including:

• Cortisol - helps the body respond to stress and controls metabolism.
• Aldosterone - helps regulate salt, water and blood pressure.
• Adrenaline - the "fight or flight" hormone.

When an adrenal gland may need to be removed

The most common reason is a tumour. Most adrenal tumours are not cancer (they are called adenomas), but they can still cause problems, mainly in two ways:

• The tumour makes too much of a hormone. For example, too much cortisol (Cushing's syndrome), too much aldosterone (Conn's syndrome), or too much adrenaline (a phaeochromocytoma).
• The tumour is too large or looks suspicious on scans, even if it is not making too much hormone.

Sometimes a small adrenal tumour is found by chance during a scan done for another reason. These are called incidentalomas and only some of them need to be removed.

What robotic adrenalectomy involves

The operation is done under general anaesthetic. A few small cuts (about 8-12 mm each) are made in the abdomen. The robotic camera and instruments are passed in.

The surgeon then carefully separates the adrenal gland from the kidney and the surrounding blood vessels, ties off the blood supply, and removes the gland through one of the small cuts.

For phaeochromocytomas, the anaesthetist takes special care to manage blood pressure changes during the operation, because these tumours can release a surge of adrenaline.

What recovery is like

• Most patients are in hospital for 1 to 2 days.
• Light activity is usually back within 1 to 2 weeks.
• Normal activity within about 2 to 3 weeks.
• Return to work within 2 to 4 weeks, depending on the kind of work.

If the tumour was making too much of a hormone, the symptoms it was causing often improve quickly once the gland is removed. Some patients need temporary hormone replacement after surgery, especially after a Cushing's-related operation.

How well it works

Robotic adrenalectomy has good outcomes in published series. Cancer-related results (where surgery is for a cancer) are comparable to open surgery, but with smaller cuts, less pain, and a quicker recovery. The chance of needing to convert to open surgery during the operation is low - under 5% in experienced centres.