Adrenal Glands: Surgical Treatment

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Dr. Austin: Welcome to an MUSC Health Podcast. I'm Dr. Linda Austin. I'm interviewing Dr. Denise Carneiro-Pla who is an Endocrine Surgeon here a the Medical University of South Carolina. Dr. Carneiro-Pla I know one of your special interests is in the surgical treatment of the adrenal glands. Just what are the diseases that might lead to surgical resection or removal of the adrenals?

Dr. Carneiro-Pla: You can have tumors that produce hormones that cause you high blood pressure, which are little tumors called pheochromocytomas. You have tumors that cause hypertension, or high blood pressure because of a hormone called aldosterone, and so you have tumors that are called aldosteronomas that produce aldosteroe. And you can have Cushing’s which also could be a tumor that produces the cortisol levels that cause many other symptomatology. So the treatment for most of these tumors is adrenalectomy, and adrenalectomy can be done in many ways. It can be done open, when we open the abdomen from the interior part of it in front of the belly- usually very large incisions- because that way you can get to the gland. Nowadays, the laparoscopic adrenalectomy is the gold standard for the treatment of adrenal tumors, and when I say adrenal tumors I'm talking about benign tumors. The tumors that produce hormones they are benign, not the malignant tumors of the adrenal. The malignant tumors of the adrenal should be treated with open surgery. They should not be done laparoscopically.

Dr. Austin: Why is that? So you can see what you're doing better?

Dr. Carneiro-Pla: So that you can take all the cells that are malignant, so you don't leave anything inside of the abdomen. So that's a rule for the surgeons, that you should take adrenals open when they have cancer. But when they are benign, you can take them laparoscopically, and you can do that from the front also. You can put three or four little holes, which are little ports, and you take the adrenal with a small camera without making a big incision in the abdomen. And as you can imagine the benefits of that are many. You have less pain, the patients recover faster, they go home faster, and the chances of herniating afterwards, having a hernia because there's small incisions are also smaller. And there's now new ways to do adrenalectomies laparoscopically, which is the posterior approach, and it's an approach that I tend to use because I think it's better for the patient. Instead of putting three or four little holes in the front, you will put in the back about three or four little holes in the back, and take an adrenal laparoscopically. Because you don't enter the abdomen, and you stay all in the back, it's better for the patient. It won't make adhesions, their bowels recover faster, they feel better, they feel less pain, and usually they discharge pretty quickly. All this information is now really statistically significant, but with the experience of the surgeons that do that, they seem like those patients, they do better laparoscopically. Not every patient can have the posterior approach. There's a certain size of tumor that you should have. There's a cut-off line, usually it's four centimeters. And patients that are obese also can not have the procedure. So, there's a limited number of patients that can have it, but the ones that can, they do very well.

Dr. Austin: How long is the recovery time from that surgery?

Dr. Carneiro-Pla: The posterior approach is actually very quick. The patients stay one or two days in the hospital. They go home, and they feel fine not too long after that. The interior laparoscopy is also very good. Patients go home in three or four days, and they do very well, sometimes three days, two days. It depends on how you recover your bowel function after surgery. The open approach is like any open surgery. Yo

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