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What the adrenalectomy surgery entails

Posted Jan 23 2009 4:21pm
Having surgery is my final suggested step. As my adrenal adenoma is unilateral (on one adrenal), I am a good candidate. Both Dr. Quinlan and Dr. Sardi agreed it was the best route for me to take to end this horrible hormonal ride. Why? Dr. Sardi explained why in very simple terms: it will more than likely cure my hypertension. It's not 100%, but he said the success rate is high and well worth the operation. After reading about the battles my fellow Conn's sufferers have had on the Yahoo Hyperaldosteronism Support group, struggling with up to 4 high BP meds daily, my decision was made. When I researched the long term effects of high blood pressure, I knew I didn't want live in fear that something awful could happen.

Another bonus is I will never have to take potassium (horse pills) supplements or continue on the spironolactone. I had originally dreaded taking spiro since the beginning, but it drastically helps, however I never want to have to rely on a drug to make me feel like a member of the human race ever again. I will also be able to hopefully cut out 2 other medications I've been on when the symptoms began. Being practically medication free is euphoric news to me.

As far as surgeons, I managed to get extremely lucky. Dr. Sardi performed one of the first Conn's related adrenalectomies and studied with the doctor the disease was named after-Dr. Jerome Conn. And the fact that Spanish is his first language is music to my ears. I expect to wake up after surgery completely bi-lingual :-)

Please note, while I have decided to go the route of surgery, it's not for everybody. Some of my fellow Conn's sufferers may have bilateral tumors or simply choose to not have surgery and continue on with the spironolactone, potassium supplements and blood pressure meds. I support each and every one them, no matter what decision they make. Living with Conn's is a difficult journey. No one is here to judge or give advice. My hope with sharing my decision for surgery is to continue to give viable options in winning the battle with Conn's.

The Laparoscopic Adrenalectomy~

DescriptionThe laparoscopic approach for adrenal resection allows small to moderately sized tumors to be removed using scopes and very small incisions. This technique is tolerated very well and has been shown to have the least amount of postoperative pain and require the shortest hospital stay. This is now the preferred method for removal of small to moderate size adrenal tumors whether they produce hormones or not.

How It's DoneThe surgeon makes a series of small ( 1/4 to 3/4 inch) incisions instead of making one large incision. This allows the surgeon access to the abdominal contents where he operates using specialized instruments. One of these instruments instills air into the abdominal cavity to blow it up (like a balloon but only under modest pressure). This instillation of air makes it easier to work since the intestines and other organs will fall away from the tissues which are being examined. A camera is then placed into the abdominal cavity which allows the surgeon to see what he is doing. The remainder of the small holes (ports) have long instruments placed through them into the abdomen for the actual dissecting of tissues. During the dissection, the pancreas and spleen must be lifted up to allow the surgeon access to the adrenal.

The adrenal vein which is smaller than the renal vein, has clips placed on it so it can be cut without bleeding. Once the adrenal artery and vein are identified, clipped, and then cut, the adrenal gland itself is dissected off of the kidney and then removed. Surgeons will put a small cloth bag through a port and into the abdominal cavity. The adrenal tumor is placed into this bag which makes it easier to remove through the relatively small skin incisions and ports.

For more in depth (and sometimes gruesome) details on this procedure, go to: http://www.endocrineweb.com/laparo.html

If you live in the Baltimore/D.C. area and need to have this done, contact
Dr. Armando Sardi
227 St Paul Place
4th Floor
Baltimore, MD 21202
410.332.9294
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