Laparoscopic and robotic adrenalectomy requires that patients undergo a general anesthesia. While operative time varies from one individual to another, the average operating time is approximately 2-3 hours.
During laparoscopic adrenalectomy approximately 3 to 4 small keyhole (< 1cm) incisions are made in the abdomen (Figure 2), which allow the surgeon to insert a telescope (called laparoscope) and hand held surgical instruments into the abdomen through portals call trocars.
Figure 2. Trocar configuration for laparoscopic and robotic adrenalectomy (courtesy of Intuitive Surgical Inc, Sunnyvale, CA).
The laparoscope allows for 10X magnification of the operative field, allowing the surgeon to accomplish the surgical procedure with improved visualization and without placing his hands into the abdominal cavity. The abdomen is filled with carbon dioxide gas to create a larger working space for the surgeon to accomplish the operation. This gas is later evacuated from the abdomen at the conclusion of the operation.
With the robotic technique, the da Vinci S Surgical Robotic System is assembled to the trocars prior to commencing the operation (Figure 3).
Figure 3. da Vinci robot assembled to the operating trocars (courtesy of Intuitive Surgical Inc, Sunnyvale, CA).
With the operating surgeon seated a few feet away at the surgeon operating console, the robotic instrumentation is controlled by the surgeon in real time with highly precise motion scaling (Figure 4).
Figure 4. Operating room configuration for left robotic adrenalectomy (courtesy of Intuitive Surgical Inc, Sunnyvale, CA).
The surgeon controls 2-3 multi-jointed robotic instruments to accomplish the tasks of dissection, cauterization, cutting and suturing (Figure 5).
Figure 5. Multi-jointed robotic instruments allow the surgeon to operate within the body with the same facility as tiny human hands.
In addition, the surgeon controls a stereoscopic lens which provides a three dimensional, high definition image of the anatomy.
The affected adrenal gland is then dissected and exposed. The tumor, adrenal gland and surrounding fat are excised along with any visible surrounding lymph nodes, preserving the adjacent organs including the liver, spleen, bowels and kidney.
Once the adrenal tumor is excised, it is immediately placed within a plastic sack and the mass is removed from the abdomen intact through one of the pre-existing abdominal incisions. Finally the skin incisions are closed using plastic surgery techniques to minimize scarring.
Potential Risks and Complications
As with any major surgery, complications, although rare, may occur with laparoscopic and robotic adrenalectomy. Potential risks and complications with this operation include but are not limited to the following:
- Bleeding: Blood loss during this procedure is typically less than 100 cc with the rare need for a blood transfusion (<2% of patients). If you are interested in autologous blood transfusion (donating your own blood) prior to your surgery, you must make your surgeon aware. This can be arranged locally in Gainesville, FL at the Civitan Regional Blood center or at your local Red Cross.
- Infection: Although patients are given broad spectrum intravenous antibiotics immediately prior to surgery, infections of the urinary tract and skin incisions may still occur but are 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 us at once.
- Adjacent Tissue / Organ Injury: Although uncommon, adjacent organs and tissues may be injured as a result of your surgery. This includes the colon, bowel, vascular structures, kidney, nerves, muscles, spleen, liver, pancreas and gallbladder. If injury to your lung cavity occurs, a small chest tube may be required to evacuate air, blood, and fluid from around your lung, thus allowing your lung to expand and work properly. On rare occasions, further surgery may be required to address unexpected injuries to adjacent organs.
- Incisional Hernia: Because of the small laparoscopic incisions, hernias at these sites can rarely develop. In addition, larger incisions are closed carefully prior to the completion of your surgery to minimize the risk of hernias.
- Conversion to Open Surgery: In the rare event of complications or due to difficulty in dissecting by means of laparoscopic or robotic surgery, conversion to open surgery is sometimes required. This could result in a larger standard open incision and possibly a longer recuperation period.