The adrenal glands are small organs that secrete hormones – such as epinephrine, norepinephrine, androgens, estrogens, aldosterone, and cortisol – which help regulate a range of bodily functions like your immune system, blood sugar levels, blood pressure control, and metabolism. They are located just above the kidneys, triangular in shape and are roughly the size of an adult thumb.
Robotic adrenalectomy is a surgical method for removal of the adrenal glands using small tools that are attached to a robotic system. Rather than the surgeon performing the procedure with their own hands, they control robotic arms with a computer. Robotic adrenalectomies are far less invasive than traditional surgery and have many advantages and health benefits.
A robotic adrenalectomy is performed by a surgeon sitting at a computer station who directs the movements of the robotic arms via a computer interface.
The robot’s camera and instrument-bearing arms are inserted through several small incisions in the abdomen. The adrenal gland is detached internally, placed in a bag, then removed through one of the incisions. The blood vessels to the adrenal gland are tied off or clipped. If the surgery is to treat malignant cancer, surrounding tissue may also be removed – this may include the removal of nearby lymph nodes.
The adrenal glands are in close proximity to other vital organs, including the vena cava, pancreas, liver and spleen, so special care must be taken during surgery so as not to disrupt any of these organs.
Robotic adrenalectomy has a number of advantages over traditional surgery, even laparoscopic surgery. Firstly, the technology used in robotic surgery enhances precision, control and flexibility of the surgeon’s movements. The robotic arms have seven degrees of freedom, which means they can move in more ways than the human wrist.
Robotic surgery also provides high definition, three-dimensional vision which allows the surgeon to distinguish vital organ close to the adrenal glands and other surrounding tissue increasing the chance of preserving them.
Advantages of robotic adrenalectomy include:
• A much shorter stay in hospital
• Decreased pain and minimal scarring
• Less blood loss and lower risk of infection
• Better visualisation which allows greater control of the surgeon’s movements and ability to perform more delicate parts of the procedure. This lowers the chance of damaging arteries supplying the adrenal gland and makes the removal of the gland much easier.
As with any surgery, there are risks associated with robotic surgery. However, the technique is very safe compared to open surgery and is now considered the gold standard that all techniques are measured against.
Side effects of removing the adrenal gland(s) include major hormone imbalances caused by the surgery. This can in turn cause affect bodily functions like healing, metabolic function, blood pressure levels and blood sugar levels.
Recovery time after a robotic adrenalectomy is much shorter than open surgery or even laparoscopic surgery.
Following the procedure, patients are taken to recovery and monitored closely. A brief 1-3 day stay in hospital is usually required.
Heavy lifting and other strenuous activities are discouraged for up to 6 weeks and driving is discouraged for up to 2 weeks. However, light activities and return to work are recommended whenever the patient feels up to it, usually 1-2 weeks after the surgery.
During his two year fellowship, Dr Arianayagam spent a significant amount of time under the tutelage of Dr Murugesan Manoharan, Professor of Urology and Program Director at the Department of Urology of the University of Miami Miller School of Medicine.
With Dr Manoharan as a mentor and teacher, Dr Arianayagam gained a wealth of experience in robotic surgery. Robotic radical prostatectomy soon became his preferred surgical method of treatment for prostate cancer. Dr Arianayagam performs robotic radical prostatectomy at both Macquarie University Hospital and Nepean Public Hospital.
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