Dr. Konstantinidis MD, PhD, FACS - General Surgeon & Director of Bariatric, Laparoscopic & Robotic Surgery of Athens Medical Center.
Surgery is the appropriate treatment for a range of benign and malignant adrenal disorders, such as pheochromocytoma, hyperaldosteronism and cancer.
The surgery of choice is called adrenalectomy (adrenal resection) and when it is performed with the assistance of a robotic system it produces an optimal medical, oncological and cosmetic outcome, eliminating the risk of complications and minimizing the inconvenience of patients.
Dr. Konstantinidis and his Surgical Team have extensive experience in dealing with even the most complex adrenal disorders, operating with the state-of-the-art robotic system, da Vinci Xi, at Athens Medical Center.
What are the adrenal glands?
The adrenal glands are small triangular glands located above each kidney and are responsible for secreting important hormones that help regulate metabolism, the immune system, blood pressure, stress response and other key functions.
The adrenal glands are made up of two parts – the cortex and the medulla – which are responsible for producing different hormones.
The cortex is divided into three distinct regions (the zona glomerulosa, the zona fasciculata and the zona reticularis), from which mineralocorticoids (mainly aldosterone), glucocorticoids (mainly cortisol), and androgens are produced.
The medulla produces epinephrine (adrenaline) and norepinephrine (noradrenaline).
What are the main Adrenal Disorders?
When the adrenal glands do not produce enough hormones, this can lead to adrenal insufficiency (Addison’s disease).
The adrenal glands can also develop nodules that can be benign or malignant, which may result in the production of excessive amounts of certain hormones that lead to various health problems.
Adrenal tumors can be either malignant (cancerous) or benign (non-cancerous), with different symptoms.
Some patients are diagnosed with primary hyperaldosteronism, a condition in which too much aldosterone is produced by the adrenal glands causing lower levels of potassium in the blood.
In 80% of cases, hyperaldosteronism is caused by an adenoma (benign tumor) in the adrenal cortex that releases excess aldosterone. Symptoms may include high blood pressure, low blood potassium levels and muscle weakness.
Hyperplasia of a tissue is not a malignancy (carcinoma) or adenoma (benign tumor), although hyperplasia in some tissues is considered precancerous. In the adrenal glands, hyperplasia of the cortex is a common cause of Cushing’s syndrome (adrenal adenoma with autonomic cortisol secretion). This syndrome is caused by excessive production – secretion of cortisol and may also be due to adrenal adenomas and carcinomas.
Another type of adrenal tumor is called pheochromocytoma. Pheochromocytomas are rare and are usually found in the adrenal medulla.
Although they can grow at any age, they usually appear between the ages of 30 and 60. Their etiology may be hereditary in people with Multiple Endocrine Neoplasia Syndrome type 2 (MEN2).
Symptoms may include headache, sweating, palpitations (tachycardia), and high blood pressure. There may also be high levels of epinephrine and norepinephrine in the urine and blood.
Other disorders of the adrenal glands that can be treated with surgery include tumors with androgen overproduction, which cause androgenetic syndrome, and non-functional tumors, as well as primary and metastatic adrenal cancer.
Adrenal metastasis is a consequence of various forms of cancer, such as small cell lung cancer, invasive breast cancer, melanoma, gastric adenocarcinoma, esophageal and liver cancer.
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How are Adrenal Disorders treated?
The diagnosis and formulation of the treatment plan for each condition is coordinated by a team of specialists, such as an Endocrinologist and a General Surgeon specializing in Endocrine Gland Surgery, who decide whether conservative or surgical treatment is required.
Most adrenal tumors can be removed with a procedure called adrenalectomy (adrenal resection).
Adrenal resection is performed for a variety of benign and malignant conditions, ranging from pheochromocytoma and hyperaldosteronism to adrenal cancer.
The conventional approach for adrenal resection, through open surgery, involves incisions in the front of the abdomen or an incision in the lower back. Both incisions are usually associated with considerable pain and prolonged periods of recovery.
Laparoscopic adrenalectomy is a minimally invasive technique that minimizes the pain and discomfort associated with these incisions.
Robotic adrenalectomy is an evolution of laparoscopic adrenalectomy.
The use of a robotic surgical system, in this case the state-of-the-art da Vinci Xi, at Athens Medical Center, maximizes the advantages of the laparoscopic approach while eliminating any of its challenges, which mainly involve technical difficulties.
What is Laparoscopic Adrenalectomy?
Laparoscopic adrenalectomy is a surgical technique applied for the removal of the adrenal glands without making a large incision.
Laparoscopic removal of an adrenal gland is a technically demanding procedure that requires specialized skills and training.
It offers substantially better eye contact with the gland compared to open surgery.
During laparoscopic adrenalectomy, a thin instrument with a camera is inserted through a small hole opened on the abdominal wall. At the same time, additional small holes are opened, through which other, thin surgical instruments are inserted to perform the procedure. The tumor is then removed along with parts of the adrenal gland and surrounding tissue.
What are the advantages of Laparoscopic Adrenal resection?
Laparoscopic adrenalectomy offers all the advantages of minimally invasive techniques:
- less postoperative pain and need for medical support after surgery
- lower incidence of complications
- shorter hospital stay
- faster return to daily activity
- better cosmetic outcome
What is Robotic Adrenalectomy?
Robotic adrenalectomy simulates performing highly advanced laparoscopic surgery yet with the help of a robotic surgical system featuring four robotic arms, which the surgeon handles while sitting on a console.
The robotic arms ensure precision, flexibility and stability of movements, incomparably superior to the human hand, ensuring the best possible access to even the most inaccessible anatomical areas in the body, as well as the least possible injury to healthy tissues during surgery.
This eliminates the technical difficulties and challenges of laparoscopic surgery as well as the risk of complications such as injury to adjacent tissues and organs.
In other words, robotic adrenalectomy warrants optimal medical, oncological and cosmetic outcome with the highest possible level of safety and surgical effectiveness.
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Why Dr. Konstantinidis?
Dr. Konstantinidis and his Surgical Team have extensive experience in dealing with even the most complex adrenal conditions, having performed a great number of robotic adrenalectomy procedures.
Robotic adrenalectomy ensures optimal medical, oncological and cosmetic outcomes with the highest possible level of safety and surgical efficiency.