Information about your procedure from

The British Association of Urological Surgeons (BAUS)

This leaflet contains evidence-based information about your proposed

urological procedure. We have consulted specialist surgeons during its
preparation, so that it represents best practice in UK urology. You should
use it in addition to any advice already given to you.
To view the online version of this leaflet, type the text below into your web
browser:
http://www.baus.org.uk/_userfiles/pages/files/Patients/Leaflets/Adrenalectomy
lap.pdf

Key Points
• The aim of this operation is to remove your adrenal gland
• You normally have two adrenal glands in the body, one sitting above
each kidney (pictured below)
• Reasons for removing your adrenal gland include benign tumours
that produce hormones and suspected (or confirmed) adrenal
cancer

What does this procedure involve?

This involves removal of your adrenal gland
through several small (keyhole) incisions.

What are the alternatives?

• Observation – this may be an option when
your tumour is very small, and the risk of
progression is felt to be low
• Partial adrenalectomy – this involves
removal of the tumour only and preserving
the rest of the adrenal gland; it is an experimental technique and is
not widely available
• Open surgery – this involves conventional removal of your adrenal
gland through a single incision

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What happens on the day of the procedure?
Your urologist (or a member of their team) will briefly review your history
and medications, and will discuss the surgery again with you to confirm
your consent.

An anaesthetist will see you to discuss the options of a general anaesthetic

or spinal anaesthetic. The anaesthetist will also discuss pain relief after the
procedure with you.

We may provide you with a pair of TED stockings to wear, and we may give
you an injection to thin your blood. These help to prevent blood clots from
developing and passing into your lungs. Your medical team will decide
whether you need to continue these after you go home.

Details of the procedure

• we normally use a full general anaesthetic and you will be asleep
throughout the procedure
• you will be given an injection of
antibiotics before the procedure, after
you have been checked for any
allergies
• we inflate your abdominal cavity with
carbon dioxide gas through a special
needle
• we place a telescope and operating
instruments into your abdominal
cavity (tummy) using three or four small incisions (pictured)
• one incision may need to be enlarged to remove the adrenal gland
• we normally insert a bladder catheter during the operation to
measure urine output
• a drainage tube may be placed through the skin into the space left
after removal of the adrenal gland
• you will be given fluids to drink immediately after the operation and
we will encourage you to move as soon as you are comfortable (to
prevent blood clots forming in your legs)
• your wound drain and catheter are normally removed after 24 to 48
hours
• the average hospital stay is three to five days

Are there any after-effects?

The possible after-effects and your risk of getting them are shown below.
Some are self-limiting or reversible, but others are not. We have not listed

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very rare after-effects (occurring in less than 1 in 250 patients) individually.
The impact of these after-effects can vary a lot from patient to patient; you
should ask your surgeon’s advice about the risks and their impact on you as
an individual:

After-effect Risk

Shoulder tip pain due to irritation of your Almost all

diaphragm by the carbon dioxide gas patients

Temporary abdominal bloating (gaseous Almost all

distension) patients

Temporary insertion of a bladder catheter Almost all

and wound drain patients

Conversion to open surgery due to failure

Between 1 in 10 &
to progress or intra-operative
1 in 50 patients
complications

Bleeding requiring further surgery or blood Between 1 in 10 &

transfusion 1 in 50 patients

Between 1 in 10 &
Wound infection
1 in 50 patients

A hernia forming in one of your port Between 1 in 10 &

incisions 1 in 50 patients

Entry into your lung cavity requiring Between 1 in 50 &

insertion of a temporary drain 1 in 250 patients

Involvement of, or injury to, local structures

(blood vessels, spleen, liver, kidney, Between 1 in 50 &
pancreas, bowel) requiring more extensive 1 in 250 patients
surgery (either immediate or deferred)

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The abnormality in the adrenal gland may Between 1 in 50 &
turn out not to be cancer 1 in 250 patients

Anaesthetic or cardiovascular problems Between 1 in 50 &

possibly requiring intensive care (including 1 in 250 patients
chest infection, pulmonary embolus, stroke, (your anaesthetist
deep vein thrombosis, heart attack and can estimate your
death) individual risk)

What is my risk of a hospital-acquired infection?

Your risk of getting an infection in hospital is between 4 & 6%; this includes
getting MRSA or a Clostridium difficile bowel infection. Individual hospitals
may have different rates, and the medical staff can tell you the risk for your
hospital. You have a higher risk if you have had:
• long-term drainage tubes (e.g. catheters);
• bladder removal;
• long hospital stays; or
• multiple hospital admissions.

What can I expect when I get home?

• you will be given advice about your recovery at home
• you will be given a copy of your discharge summary and a copy will
also be sent to your GP
• any antibiotics or other tablets you may need will be arranged &
dispensed from the hospital pharmacy
• there may be minor discomfort from the small incisions in your
abdomen but this can normally be controlled with simple painkillers
such as paracetamol
• all the port incisions are closed with absorbable stitches which do not
require removal, but may take two to three weeks to disappear
• if you develop a temperature, increased redness, throbbing or
drainage at the site of the operation, you should contact your GP
immediately.
• it will take 10 to 14 days to recover fully from the procedure
• most people can return to normal activities after two to four weeks.
• a follow-up outpatient appointment will normally be arranged for you
at 6 to 12 weeks after the operation when we will let you know the
results of pathology tests on the removed adrenal gland.
• it will be 14 - 21 days before the biopsy results on the tissue removed
are available. All biopsies are discussed in detail at a multi-

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 disciplinary meeting before any further treatment decisions are
made. You and your GP will be informed of the results after this
discussion.

Your remaining adrenal gland will function normally on its own. It is

sometimes necessary to take drugs to help the remaining gland recover (e.g.
in patients with Cushing’s syndrome). If both glands have to be removed
(this is very rare), you will need to take drugs to replace their function.

General information about surgical procedures

Before your procedure
Please tell a member of the medical team if you have:
• an implanted foreign body (stent, joint replacement, pacemaker,
heart valve, blood vessel graft);
• a regular prescription for a blood thinning agent (e.g. warfarin,
aspirin, clopidogrel, rivaroxaban, dabigatran);
• a present or previous MRSA infection; or
• a high risk of variant-CJD (e.g. if you have had a corneal transplant, a
neurosurgical dural transplant or human growth hormone
treatment).

Questions you may wish to ask

If you wish to learn more about what will happen, you can find a list of
suggested questions called "Having An Operation" on the website of the
Royal College of Surgeons of England. You may also wish to ask your
surgeon for his/her personal results and experience with this procedure.

Before you go home

We will tell you how the procedure went and you should:

• make sure you understand what has been done;

• ask the surgeon if everything went as planned;
• let the staff know if you have any discomfort;
• ask what you can (and cannot) do at home;
• make sure you know what happens next; and
• ask when you can return to normal activities.

We will give you advice about what to look out for when you get home.
Your surgeon or nurse will also give you details of who to contact, and how
to contact them, in the event of problems.

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Smoking and surgery
Ideally, we would prefer you to stop smoking before any procedure.
Smoking can worsen some urological conditions and makes complications
more likely after surgery. For advice on stopping, you can:
• contact your GP;
• access your local NHS Smoking Help Online; or
• ring the free NHS Smoking Helpline on 0300 123 1044.

Driving after surgery

It is your responsibility to make sure you are fit to drive after any surgical
procedure. You only need to contact the DVLA if your ability to drive is
likely to be affected for more than three months. If it is, you should check
with your insurance company before driving again.

What should I do with this information?

Thank you for taking the trouble to read this information. Please let your
urologist (or specialist nurse) know if you would like to have a copy for
your own records. If you wish, the medical or nursing staff can also arrange
to file a copy in your hospital notes.

What sources have we used to prepare this leaflet?

This leaflet uses information from consensus panels and other evidence-
based sources including:
• the Department of Health (England);
• the Cochrane Collaboration; and
• the National Institute for Health and Care Excellence (NICE).

It also follows style guidelines from:

• the Royal National Institute for Blind People (RNIB);
• the Information Standard;
• the Patient Information Forum; and
• the Plain English Campaign.

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Disclaimer
We have made every effort to give accurate information but there may still
be errors or omissions in this leaflet. BAUS cannot accept responsibility for
any loss from action taken (or not taken) as a result of this information.

PLEASE NOTE
The staff at BAUS are not medically trained, and are unable to answer
questions about the information provided in this leaflet. If you do have
any questions, you should contact your urologist, specialist nurse or GP.

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Due for review: August 2024 © British Association of Urological Surgeons (BAUS) Limited