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Minimally Invasive Adrenal Surgery
Minimally Invasive Adrenal Surgery - POSTERIOR RETROPERITONEOSCOPIC ADRENALECTOMY
Minimally invasive adrenal surgery - posterior retroperetoneaoscopic adernalectomy is performed for:
1. Adrenal tumors (incidentaloma)
2. Cushing's syndrome
3. Hyperaldosteronism (primary hyperaldosteronism)
4. Pheochromocytoma
Now Available – "The Atlas of Adrenal Surgery" by Alexander Shifrin, MD, published by Springer
This new atlas by Dr. Alexander Shifrin is designed to present a comprehensive and state-of-the-art approach to a single surgical procedure - adrenal gland surgery.
The Atlas of Adrenal Surgery by Alexander Shifrin, MD
Adrenal Incidentaloma, Pheochromocytoma, Cushing's Syndrome (adrenal), Primary Hyperaldosteronism (aldosteronoma), sex hormone producing adrenal tumors (virilizing adrenal tumors)
Minimally Invasive Adrenal Surgery
Minimally invasive adrenal surgery is the laparoscopic removal of an adrenal tumor through the abdominal or back approaches (posterior retroperitoneoscopic adrenalectomy). There will be three small incisions instead of one large one, as was the case in the past. This technique speeds up the healing process and reduces scar formation. The best approach for patients, and the one I am using at this time, is posterior retroperitoneoscopic adrenalectomy (posterior laparoscopic adrenalectomy from the back) - laparoscopic surgery through the back. It is a more modern, advanced technique developed by Professor Waltz in Germany. It has a significant advantage of avoiding entry into the abdominal cavity, resulting in significantly less post-operative pain, a quicker recovery, and the ability to be performed on any patients, even those who have had multiple abdominal surgeries and developed severe adhesions. The cosmetic result is much better than the abdominal approach. Almost every surgeon in the United States and all over the world, who can perform this technique, had to visit Dr Walz's Hospital in Germany and learn the technique of posterior adrenalectomy from him.
Scar in two weeks after the left transperitoneal laparoscopic adrenalectomy (through the abdomen).
Scar in two weeks after the left posterior retroperitoneoscopic (laparoscopic approach through the back) adrenalectomy for pheochromocytoma.
SURGERY:
Anesthesia
The procedure is done under general anesthesia. Patient's position for Posterior Retroperitoneoscopic Adrenalectomy is prone. Our Anesthesia Team (an anesthesiologist and a nurse anesthetist) is highly qualified and experienced in providing anesthesia in this specific patient’s position. They also have an outstanding level of expertise in giving anesthesia to patients with multiple medical co-morbidities and also for providing a particular type of anesthesia for patients with hypertension secondary to Pheochromocytoma, Cushing’s syndrome, and hyperaldosteronism.
Your Operating Room
All adrenal surgeries, including Posterior Retroperitoneoscopic Adrenalectomy (adrenal laparoscopic surgery from the back), are performed in a specially designed State-of-the-Art Laparoscopic Operating Room. This operating room is equipped with cutting-edge laparoscopic equipment and a specifically designed table that allows for patient positioning for this highly sophisticated procedure.
State-Of-Art Laparoscopic Operating Room
Your Surgery
Posterior Retroperitoneoscopic Adrenalectomy (adrenal laparoscopic surgery from the back) is performed in a patient's position, lying prone on a specially designed table.
The Atlas of Adrenal Surgery by Alexander Shifrin, MD
Patient’s position for posterior retroperitoneoscopic adrenalectomy (laparoscopic adrenal surgery from the back). Click on image to view video “Minimally Invasive Posterior Retroperitoneoscopic Adrenalectomy.
Length of hospital stay and Postoperative Care
All patients after adrenal laparoscopic surgery, including Posterior Retroperitoneoscopic Adrenalectomy, will stay in the recovery room for 30 min to an hour and then will stay on the floor for 23 hours (overnight stay only) in a specially designed, state-of-the-art patient’s room with a flat screen TV. The room is equipped with cutting-edge, sophisticated equipment, a Private Bath with an ADA-compliant roll-in Shower, and a Corian Sink. Each room has an additional couch for your accompanying person to rest. Concierge Service is available.
Pain
Postoperatively, most of the patients have little pain, which is easily controlled with postoperative pain medications or injections. It is especially true for posterior retroperitoneoscopic adrenalectomy. With this approach, the patient is almost pain-free on the day of surgery, and most patients take only one pain pill that day and return to their normal routine the day after surgery.
Drain:
There will be no drain placement.
Stitches and Scars:
The surgery will be performed through 3-4 small incisions, the stitches will be small, subcutaneous, which dissolve on their own and do not require removal. Either skin glue or Steri-strips will be applied and will stay for about a week. They will peel off on their own. Because the incisions will be small and the stitches will be subcutaneous, the size of the scar will be much less than that of traditional open surgeries performed in the past.
However, the scarring tendency is dependent on the individual's skin healing properties. The surgeon will make every effort to achieve the best possible cosmetic result.
COMPLICATIONS:
Bleeding:
With the current technique, the incidence of bleeding is minimal.
Wound infection:
With the current technique, the incidence of wound infection is minimal.
POSTOPERATIVE CARE:
Incision site:
Skin glue will stay for about 10 days and will come off by itself. The Steri-strips will peel off on their own in 6-8 days. After that, you can apply moisturizer to the wound, use Mederma or lotion with Vitamin E.
Physical restrictions:
There will be limited physical restrictions for about 2 - 4 weeks after the surgery. Most patients resume their normal physical activities within several days after surgery, especially those who have undergone a posterior approach.
Shower:
You can take a shower in 48 hours (2 days) after the surgery. Do not scratch or peel off the Steri-strips or glue; just wipe them with the towel.
Pathology report:
Usually available within 5-7 days after the surgery
Problem calls:
Please immediately call a doctor if you develop significant pain, abdominal swelling, fever, or chills, or if your incisions become very red after the surgery. We are available 24 hours a day, 7 days a week, on call on our cell phones.
Postoperative visit:
2-3 weeks after the surgery: for wound check and pathology report.
Posterior retroperitoneaoscopic adrenalectomy:
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Incision covered with skin glue, immediately after the removal of the large (5 cm = 2 inch) right adrenal tumor by posterior retroperitoneoscopic adrenalectomy (laparoscopic adrenal surgery from the back)
Scars, 4 weeks after posterior retroperitoneoscopic adrenalectomy (laparoscopic adrenal surgery from the back)
Large (5 cm = 2 inch) right adrenal tumor removed from the patient above by posterior retroperitoneoscopic adrenalectomy (laparoscopic adrenal surgery from the back)
Scars, 2 weeks after the removal of the left adrenal tumor by posterior retroperitoneoscopic adrenalectomy (laparoscopic adrenal surgery from the back)
Left adrenal tumor removed from the patient pictured above by posterior retroperitoneoscopic adrenalectomy (laparoscopic adrenal surgery from the back)
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Dr Shifrin authored NADF’s (The National Adrenal Diseases Foundation) new “Pheochromocytoma: The Fact You Need to Know” patients’ education pamphlet
The Atlas of Adrenal Surgery by Alexander Shifrin, MD
For more information and pictures, please visit my other web page
www.AdrenalTumors.ORG
or CLICK ON THE IMAGE BELOW
Now Available – "The Atlas of Adrenal Surgery" by Alexander Shifrin, MD, published by Springer
This new atlas by Dr. Alexander Shifrin is designed to present a comprehensive and state-of-the-art approach to a single surgical procedure - adrenal gland surgery.
