Advances in Adrenal Surgery
The adrenal glands, located adjacent to the kidneys, produce hormones including aldosterone, cortisol, adrenaline, testosterone, and estrogen. Tumors may form in the glands, causing overproduction of one or more of these hormones. In such cases, surgical removal of the tumor may be necessary.
At the Department of Surgery, endocrine surgeons are utilizing a new approach, retroperitoneal adrenalectomy, to remove such tumors. In this procedure, the surgeon makes three laparoscopic incisions in the patient's back underneath the rib cage. Through these tiny ports, he or she inserts surgical and imaging instruments and removes the tumor.
At virtually every other U.S. center, laparoscopic adrenalectomy is performed through the belly, according to James A. Lee, MD, Director, Columbia Adrenal Center, Chief, Endocrine Surgery Section, and Co-Director, New York Thyroid/ Parathyroid Center. When the surgical approach to the tumor comes from the back, patients seem to experience less pain and have fewer complications such as hernias, he explains. In addition, the new procedure takes half as much time as the traditional approach (about 30 to 45 minutes compared to an hour or hour and a half). As an added benefit, patients may prefer the retroperitoneal approach for cosmetic reasons.
Dr. Lee and William B. Inabnet, MD, brought the new approach back to the U.S. after learning it in Germany, where surgeons developed and perfected the technique.
Although there is plenty of evidence to support the benefits of a retroperitoneal approach, Adrenal Center physicians want to make sure that this technique really does offer significant benefits to their patients. In a randomized, controlled trial at Columbia University Medical Center, half of patients will have surgery via the traditional frontal approach, while the other half will undergo the retroperitoneal procedure. Eligible patients cannot be morbidly obese, and their tumors must be less than six centimeters in size.
This new approach represents one of many ways in which the Adrenal Center is working to advance the care of patients with adrenal disease.
Always looking to the next frontier, Dr. Lee says, "We are currently using three incisions to do this procedure, but we expect to be able to do this through a single incision in the near future."