Adrenalectomy new

adrenalectomy

1. ADRENALECTOMY Dr. SUBBAIAH. M.P.T

2. ADRENALECTOMY DISORDERSS OF ADRENAL GLAND

3. ANATOMY W ei g h t = 4g 2 a d r e na l gl a n d , ri g h t a n d left 2 com p onen t ; in n er a d r e na l m e d u ll a a n d o u ter a d r e na l co r tex Situated ne a r up p er p o le s o f kid n ey s in retro peritoneum, with i n Ger o ta ’ s capsu le

4. ANATOMY CON’T Ri g h t a d r e na l gl a nd – b e twe e n ri g ht liv e r lo b e a n d di a ph r agm L e ft a d r e na l gl a n d – close to u p p e r p o le o f lef t kidn e y and r e n a l p e dic l e, cov e r e d by pa n creatic tail and spl e en

5. ANATOMY CON’T Arterial bl o o d sup p l – su p erio r su p r a r e nal a r tery (fr o m i n fer i o r p h r e n i c arte r y) - mi d dl e su p r a renal a r tery (fr o m a b d o m i n a o rta) - inf e ri o r su p r a renal a r tery (fr o m r e n a l a r tery)

6. DEFINITION Adrenalectomy     is the surgical removal of one or both ( bilateral adrenalectomy )  adrenal glands .  It is usually advised for patients with tumors of the adrenal glands.  The procedure can be performed using an open incision ( laparotomy ) or  laparoscopic  technique.

7. INDICATIONS Conn syndrome. Cushing syndrome. Pheochromocytoma. Large myelolipoma. Metastatic tumors. Adrenocortical carcinoma. Neuroblastoma (pediatric population)

8. Conn syndrome Primary  aldosteronism , also known as primary hyperaldosteronism  or  Conn's syndrome , is excess production of the hormone aldosterone by the adrenal glands resulting in low renin levels. Often it produces few  symptoms . Most people have high blood pressure which may cause poor vision or headaches.

9. CUSH I NG’S SYNDROME Cushing's syndrome  is caused by either excessive cortisol-like medication such as prednisone or a tumor that either produces or results in the production of excessive cortisol by the adrenal glands.

10. 3.PHEOCHROMOCYTOMA Pheochromocytoma  is a rare tumor of adrenal gland tissue. It results in the release of too much epinephrine and norepinephrine, hormones that control heart rate, metabolism, and blood pressure.

11. LARGE MYELOLIPOMA Myelolipoma  (myelo-, from the ancient greek marrow; lipo,  meaning  of, or pertaining to, fat; -oma  meaning  tumor or mass) is a benign tumor-like lesion composed of mature adipose (fat) tissue and haematopoietic (blood-forming) elements in various proportions.

12. METASTASTIC TUMORS Metastasis  is the spread of  cancer  cells to new areas of the body (often by way of the lymph system or bloodstream). A  metastatic cancer , or  metastatic tumor , is one which has spread from the primary site of origin (where it started) into different area(s) of the blood

13. ADRENO CORTICAL CARCINOMA Adrenocortical carcinoma  is a rare disease in which malignant ( cancer ) cells form in the outer layer of the adrenal  gland. There are two  adrenal  glands. The adrenal  glands are small and shaped like a triangle. One  adrenal  gland sits on top of each kidney.

14. 6. NEUROBLASTOMA Neuroblastoma  (NB) is a type of cancer that forms in certain types of nerve tissue. It most frequently starts from one of the adrenal glands, but can also develop in the neck, chest, abdomen, or spine. ..

15. PRIM A R Y HYPE R ALDOS T ERO N ISM (PHA) Hype r ten s io n , Hypok a lemi a , Hy p e r se c re t i o n o f al d osterone Hyp e rtensive p a tie n t wit h hy p ok a laemi c PHA~ 2% Hyp e rtensive p a tie p o tassi u m : 1 2 %

16. SURGERY OF THE ADRENAL GLANDS  LA P AR O SC O PIC AD R EN A LEC T O M Y :  RIGH T AD R EN A LEC T OMY  LEF T AD R EN A LEC T O MY  R E T R O P E R I T O N EOSCO P IC AD R EN A LEC T O MY  OP E N AD R EN A LEC T O MY

17. TYPES OF ADRENALECTOMY The two types of adrenalectomy Open adrenalectomy Laparoscopic adrenalectomy

18. OPEN ADRENALECTOMY An open adrenalectomy is often required when either the adrenal glands or the tumors are abnormally large.  In this procedure a single incision is made either in the  abdominal  wall just under the  ribcage , or the back or sides.

19. OPEN ADR E NAL E C T OMY Ma l ig n an t ad r ena l tumo u r suspected Rt sid e : h e p a tic flex u re o f the col o n is m o bi l ise d & t h e r t liv e r lo b e i s cr a ni a lly retr a c t e d to ach i ev e a n optima l exp o sure of the IVC & the a d r e na l gl a nd L f sid e : AG can b e ex p os e d afte r m o bi l isati o n o f the spl e ni c flex u re o f the col o n,thr o ug h the transver s e mes o colo n / the gastr o c o lic li g a m e n t Res e ction o f r e gi o n a l lym p h n o d e is rec o mm e nd e d an d sho u l d incl u d e res e ction of the tissue b e twe e n the r e n a l p e dic l e

20. LAPROSCOPIC ADRENALECTOMY Laparoscopic adrenalectomy  is the procedure of choice for benign (non-cancerous) adrenal tumors .     Laparoscopic  surgery has proved to be a major advancement for the management of adrenal tumors.

21. RIGH T ADR E NAL E C T OMY Position: right side up,wit h table brake Disse c tion s t ar t a t the leve l of the periadrena l fat Peritoneum i s divide d 2c m belo w th e edg e o f liver from m e dial(IV C ) to the latera l abd o mi n a l wall Flap o f peritoneu m c a n b e use d to retract the liver u p & o f f the adren a l Identify the glan d an d m o bilis e gentl y , securing the vein w it h a clip/us in g on e o f the available energ y device Re m ov e the glan d i n a pla s tic

22. RIGHT ADRENALECTOMY LAPROSCOPIC PROCEDURE

23. LEF T ADR E NAL E C T OMY Position: ri g h t side M o bi l isati o n o f the sple e n wi l l dis p lac e the p a nc r eati c tail me d ia l ly Incison o f Gerota ’ s fasc i a i s f o l l o w e d by id e ntific a tion o f the a d r e na l vein The r e secti o n i s co m pl e t e d b y m o bi l isi n g the ad r ena l gl a n d a t the lev e l o f the pe r ia d re n a l fat Re m ov e the gl a n d i n a b a g

24. LEFT ADRENALECTOMY LAPROSCOPIC PROCEDURE

25. RE T RO P ERI T ON E OS C OPIC ADR E NALE C T OMY 1 S T po r t: dista l en d o f the 1 2 th ri b ( p rone p o sitio n ) Di g ita l dissecti o n int o the r e trope r itoneum , Gerota ’ s fasc i a i s dis p l a ced ve n tr a l l y R A V i s cover e d b y the r e trocaval p o ster i or as p ec t o f the a d r e na l gl a nd L A V i s locate d a t the me d ia l infe r io r po l e o f the a d r e na l gl a nd Hi g h infl a tion p r ess u r e s al l o w bl o o d less dissecti o n e f fectiv e l y tamp o na d in g the veins

26. COMPLICATIONS Insufficient cortisol production. Decreases in blood pressure. Bleeding. Infections in the wound, urinary tract, or lungs. Blood clots in the legs. Injury to nearby organs or structures. Adverse reaction to anesthesia.