Бүйрекүсті бездерін хирургиялық жолмен алып тастау

Surgical removal of adrenal glands

Adrenalectomy (Latin root Ad "near/at" + renal "related to the kidneys" + Greek ‑ectomy “out cutting”; sometimes written as ADX for the procedure or resulting state) is the surgical removal of one (unilateral) or both (bilateral) adrenal glands. It is usually done to remove tumors of the adrenal glands that are producing excess hormones or is large in size (more than 2 inches or 4 to 5 centimeters). Adrenalectomy can also be done to remove a cancerous tumor of the adrenal glands, or cancer that has spread from another location, such as the kidney or lung. Adrenalectomy is not performed on those who have severe coagulopathy or whose heart and lungs are too weak to undergo surgery. The procedure can be performed using an open incision (laparotomy) or minimally invasive laparoscopic or robot assisted techniques. Minimally invasive techniques are increasingly the gold standard of care due to shorter length of stay in the hospital, lower blood loss, and similar complication rates.

Most adrenal tumors are noncancerous (benign), often found incidentally as a mass via imaging such as CT scans, MRI, or ultrasound that were taken for other health workups (see incidentaloma). Although these adrenal masses do require evaluation, the majority of them (approximately 80%) do not require adrenalectomy. However, due to the hormone producing function of the adrenal glands, some noncancerous adrenal tumors may produce too much hormones, such as aldosterone (called primary aldosteronism), cortisol (called Cushing's disease or Cushing's syndrome), or catecholamines (called pheochromocytoma). These hormone producing tumors may need adrenalectomy. Additionally, adrenal tumors that are larger than 4 centimeters in size, regardless of whether they produce hormones, also require adrenalectomy due to increased risk of adrenal cancer. Rarely (5–12%), the adrenal tumor may be cancerous (adrenocortical carcinoma), requiring adrenalectomy. Rarer still, the mass may be a metastatic cancer that spread from another location, such as the kidney or lung. If the metastasis is isolated to the adrenal gland, it may be a candidate for adrenalectomy.

Techniques for adrenalectomy is largely divided into two types: open surgical laparotomy versus minimally invasive techniques.

Surgeons usually reserve open surgery for large (larger than 6 cm) or cancerous tumors where there is a risk of not fully removing the cancerous tissue. They perform open surgery using traditional instruments and cuts (incisions). For outcomes such as all cause mortality, early morbidity, socioeconomic effects, and operative and postoperative parameter, the evidence is uncertain about the effects of either interventions over the other. Sometimes surgeons perform robot assisted adrenalectomies. They perform the surgery through small cuts (incisions) using robotic arms with a camera and instruments attached. The camera gives doctors a high definition, magnified, 3D view of the surgical site. No significant differences were found between laparoscopic and robot assisted adrenalectomy in two meta analyses for complications, blood loss, or mortality, however robotic adrenalectomy had shorter hospital stays at the cost of longer operating time and higher cost of surgery. If both adrenal glands are removed, the patient can no longer create the adrenal hormones necessary for life (primary adrenal insufficiency). Signs and symptoms include volume depletion, hypotension, hyponatremia, hyperkalemia, fever, abdominal pain. This requires lifetime treatment with the hormones produced by the removed adrenal glands, including glucocorticoids and mineralocorticoids (fludrocortisone). The glucocorticoid dose needs to be increased when in stress or during infections or else adrenal crisis may occur. For women with deficiency in androgens as a result of the loss of androgen production from the adrenal glands following adrenalectomy, dehydroepiandrosterone (DHEA) replacement can be considered. The signs and symptoms include low libido, depressive symptoms, and/or low energy levels despite optimized glucocorticoid and mineralocorticoid replacement.

Complications from an adrenalectomy can include insufficient cortisol production, acute kidney injury, post operative bleeding, damage to nearby organs, and post operative infection.