Robotic Adrenalectomy

The adrenal glands are two small glands that lie atop the kidneys. They produce important hormones that regulate blood pressure, sugar &salt levels in the body. These hormones include cortisol, aldosterone, epinephrine (adrenaline), and norepinephrine.

Adrenal tumors are rare but can cause significant problems including hypertension, sweating, palpitations, weight gain, headaches and other symptoms as a result of abnormal hormone production from the adrenal mass. “Functional” adrenal tumors include pheochromocytoma, aldosteronoma, Cushing’s tumor and adrenal cancer. Some adrenal tumors are non-functional and cause no symptoms. These patients may be detected incidentally on routine imaging for some other causes.

Robotic & laparoscopic adrenalectomy provides patients with minimally invasive technique for removal of an adrenal mass.The advantage of improved cosmesis, reduced pain, blood loss, and hospital stay, as compared to conventional open surgery accrue anyways.However in select patients with very larger tumors, laparoscopic and robotic adrenalectomy may not be feasible and therefore open adrenalectomy may be advised.

The Surgery

This surgery is done under G.A & takes approximately 2-3 hours.

During robotic adrenalectomy approximately 4 to 5 small (< 1cm) incisions are made in the abdomen, where ports are placed to access the abdomen & perform the surgery.

The robot allows up to 16X magnification allowing improved visualization.Carbon dioxide gas is used to distend the abdomen to achieve a larger working space during surgery. The gas is evacuated from the abdomen at the conclusion of surgery.

The robot is docked to the ports. The surgeon sits on the console with an assistant by the patient side.

The robotic instruments are controlled by the console surgeon with highly precise motion scaling.

Three dimensional, high definitionimage of the robotic lens provides better depth perception leading to precise dissection. The adrenal gland is then dissected and exposed. Any surrounding lymph nodes are excised along with if indicated.

The adrenal tumor is placed within a plastic bag and through one of the pre-existing abdominal incisions. The ports & skin incisions are closed.

 

Potential Risks and Complications

Potential risks and complications with this operation include but are not limited to the following:

Bleeding: Blood loss during this procedure is usually less than 200 ml. Transfusion is rarely required.

Infection: Rare. If you develop any signs or symptoms of infection after the surgery (fever, drainage from or redness around your incisions, urinary frequency/discomfort, pain) please contact Dr Manav Suryavanshi at once.

Adjacent Tissue / Organ Injury: Rare but possible. Injuries could include the colon, bowel, vascular structures, kidney, spleen, liver, pancreas and gallbladder. In cases where injury to the diaphragm occurs, a chest tube may be placed to drain air, blood, and fluid from the lung cavity. This allows your lung to expand and work properly.

Incisional Hernia: Port sites may rarely develop hernias which may need repair if it ever occurs.

Conversion to Open Surgery: Patient needs to understand a consent for a robotic or laparoscopic procedure entails a consent for conversion to open surgery as & when required, keeping the patient safety paramount. This may give them a larger open incision and longer recovery period.

Tubes to be expected in body after surgery

A Foleys catheter is placed to drain the bladder. This helps to monitor your urine output over the first 1-2 days after surgery. This is removed once the patient is walking comfortably over next 1-2 days.

 

What To Expect After Surgery

Post the surgery you will be shifted to the recovery room then transferred to the ward 2-3 hours down the line. Patients with functioning tumors may be kept in ICU for a day to monitor the hemodynamic stability.

Postoperative Pain: Patients experience some pain at their incision sites, which is controlled by i.v pain medications, patient-controlled anesthesia pump, or oral pain tablets. Sometimes some minor transient shoulder pain (1-2 days) occurs due to the carbon dioxide gas used to inflate the abdomen during surgery.

Nausea: Nausea may occur related to G.A. This is controlled by SOS medications.

Diet: Diet is advanced slowly from liquids to solids as tolerated. By the second day post surgery the patient is usually back to his normal diet. During this time the i.v drips provide the necessary hydration to your body till your oral intake improves.

Fatigue: Fatigue is common following surgery and subsides in a few weeks.

Incentive Spirometry: Simple breathing exercises help prevent respiratory infections. Our physiotherapist shall teach these exercises done by incentive spirometer to you. Coughing and deep breathing is an important part of recovery and helps prevent pulmonary complications.

Ambulation: We ambulate the patients by the evening & encourage them to get out of their beds under the supervision of the nurse as this helps to prevent blood clots from forming in the legs. From day 1 after surgery we encourage patients to walk 4-6 separate times a day. This reduces the chances of deep vein thrombosis and helps faster return of bowel function.

Constipation/Gas Cramps: Patients maybe constipated for several days following surgery as a result of the anesthesia. Suppositories and stool softeners are given to help with this problem. Narcotic pain medication can also cause constipation and are preferably discontinued after surgery as soon as the patient tolerates the pain.

Hospital Stay: The length of hospital stay following robotic adrenalectomy is generally 2-3 days.

 

What To Expect After Discharge From The Hospital

Pain Control: After discharge the patients usually need to take pain medications only on an SOS (as & when required) basis.

Showering: Patients can shower immediately upon discharge from the hospital. Pad your incision sites dry and avoid any heavy creams or lotions. Tub baths in the first 2 weeks are discouraged as this will allow for prolonged soaking and increase the risk of infection. As our patients are discharged we place healex spray (invisible polyurethane dressings) over the incision whichacts as a barrier to infection and will fall off over time. Alternatively, adhesive tape may be placed across your incisions. These can be removed 3-5 days following surgery. The sutures underneath the skin will dissolve in 4-6 weeks. If the skin has been stapled with clips then the patients will need to visit & get them removed 7-8 days after surgery.

Activity: Walking in first two weeks after surgery is encouraged as it reduces the risk of pneumonia and deep vein thrombosis. It is permissible to climb stairs. No heavy lifting or exertion for up to 4 – 6 weeks following surgery. Patients may begin driving once they are off narcotic pain medication (cause dizziness & may increase reaction times) and have full range of motion at their waist. Most patients can return to full activity including work on an average 3-4 weeks after robotic adrenalectomy.

Diet: Patients may resume a regular diet as tolerated; usually 2-3 days after surgery.

Follow-up Appointment: Patients should make a follow-up appointment by contacting the Dr Manav Suryavanshiat +91-9910103545.We shall let you know the timing and schedule of clinic visits following surgery.

Pathology Results: The pathology results from your surgery are usually available in one week following surgery. Your results will be discussed with you directly in the office during a follow-up clinic appointment. Please avoid telephonic communications as these can lead to misinterpretations.

Frequently Asked Questions (Faqs)

What is the advantage of robotic adrenalectomy as compared to open surgery?

Benefits of minimally invasive techniques include reduced blood loss and transfusions, reduced pain, shorter hospital stays, improved cosmesis, and a faster recovery as compared to open surgery. Open surgery requires either a large abdominal or flank incision.Outcomes of laparoscopic and robotic adrenalectomy demonstrate comparable cure rates to open surgery.

What patients are not good candidates for robotic adrenalectomy?

Patients with very large tumors or tumors invading surrounding structures e.g. vena cava, kidney, liver, bowel may be offered an open approach due to the extent and need for adjacent organ resection. Medical conditions such as severe lung and heart disease may also contraindicate robotic approach. This is decided by our anesthetist at your preanesthesia checkup.

What is the difference between a laparoscopic and robotic approach?

Both are minimally invasive approaches. Operative times, blood loss, and hospital stays are similar between both the techniques.Laparoscopic surgery involves hand held instruments, while robotic surgery involves the use of a robotic interface with wristed instrumentation. In robotic surgery the surgeon controls these instruments externally from a surgeon console.

What happens if complications arise and conversion to open surgery is required?

Although extremely rare, conversion to open surgery may be required if difficulty with dissection is encountered during minimally invasive approach, keeping the patient safety paramount.

Will I need further treatment such as radiation or chemotherapy following surgery?

Most adrenal tumors are benign and therefore prognosis remains excellent as most are cured with surgery alone. Rarely, patients may have large, invasive cancers that may require adjuvant treatment under the care of a medical oncologist.

For More Information

Meet us at

Medanta Kidney & Urology Institute

Medanta – The Medicity

Sector 38, Gurgaon, Haryana – 122001, India

For appointment Call+91-9910103545

Email – info@urofort.com

Web address – www.manavsuryavanshi.com