Adrenal tumours are relatively rare but can be the cause of hypertension with excess 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. This include adrenal adenoma and angiomyolipoma. 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.
How it is done
Under general anaesthesia, the patient is placed in a lateral position and pressure points are padded. A camera port is inserted, abdomen distended with gas and two working ports are then inserted under direct vision. The adrenal gland is exposed and all the blood vessels supplying it are sealed with diathermy or energy-sealing device. The whole gland and tumour is placed in a plastic bag and extracted at the end of the surgery.
Patient position for laparoscopic / robotic adrenal surgery
Robotic arms in position
The robotic method makes the surgery even safer (less blood loss, lower conversion rate) through its superior technology combining 3-dimensional, 10-times magnified vision with dextrous instruments. The surgery takes 2 to 3 hours for standard laparoscopic method, but is shorter (1 to 2 hours) for robotic method. Hospital stay is 2 days on average.
Dr Chin performing robotic adrenalectomy on Si robot
Scars from robotic right adrenalectomy for a 8.5 cm adrenal angiomyolipoma in a 78 kg woman
- bleeding. Blood loss is generally low (< 100 ml) but in the event of excess bleeding, blood transfusion may be needed.
- blood pressure fluctuations. This applies to functional tumours, especially pheochromocytoma and Conn’s syndrome, where 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 while handling of the tumour during dissection. Such fluctuations in blood pressure can cause major 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 much lower with robotic method.
- no blood transfusion ( < 1% risk )
- no excessive blood pressure changes
- no conversion to open surgery ( < 5% chance )