Robotic/Laparoscopic Adrenalectomy

Adrenal tumours are relatively rare but can be the cause of medical symptoms like hypertension, excessive sweating, palpitations, weight gain, headaches and water retention as a result of excess hormone production. These “functional” or hormone-secreting tumours include pheochromocytoma, Conn’s syndrome, Cushing’s tumour and adrenal cancer. Adrenal tumours may also be non-functional and cause no symptoms; these are picked up from incidental screening. For patients diagnosed with small adrenal tumours less than 6 cm, they no longer need open surgery to remove them. Laparoscopic and robotic adrenalectomy are minimally invasive techniques that can now be done safely with faster recovery.

These keyhole approaches have the advantage of less blood loss, less pain, smaller scars and shorter hospital stay. In addition, the robotic method makes the surgery even safer through superior technology consisting of 3-dimensional, 10-times magnified vision and dextrous instruments.

The surgery takes 3 to 4 hours for standard laparoscopic method, but shorter (< 2 hours) for robotic method. Complications include.

  • bleeding. Blood loss is generally low (< 100 ml) but in the event of major bleeding from large vessel injury, blood transfusion may be needed.
  • blood pressure fluctuations For functional tumours, especially pheochromocytoma and Conn’s syndrome, a sudden drop in blood pressure can occur once the adrenal vein is ligated. In addition, for pheochromocytoma, the blood pressure can rise to dangerous levels during handling of the tumour. Such fluctuations in blood pressure can be severe enough to cause strokes and heart attacks.
  • conversion As with all laparoscopic techniques, conversion to open surgery is always possible if excess difficulty or bleeding is encountered. The conversion rate is lower with robotic method.

Desired outcomes:

  • no blood transfusion ( < 1% risk )
  • no excessive blood pressure changes
  • no conversion to open surgery < 5% chance )