Canberra Endocrine & General Surgery

Diagnosis and Preoperative Evaluation
 
A careful and structured evaluation is essential before considering adrenal surgery. Dr Hazel Serrao-Brown will provide a thorough diagnostic process to confirm the nature of the adrenal condition and whether you are suitable for surgical intervention.
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• Initial Assessment
  You may present with symptoms such as high blood pressure, unexplained weight changes, fatigue, or hormonal imbalances. A detailed medical history and physical examination are the first steps in identifying potential adrenal disorders.

• Hormonal Testing
  Blood and urine tests are performed to detect excess hormone production. These may include tests for cortisol (Cushing’s syndrome), aldosterone (Conn’s syndrome), and catecholamines (pheochromocytoma), depending on the suspected condition.

• Imaging
  CT scans or MRI are used to assess the size, shape, and characteristics of adrenal masses. These imaging techniques help distinguish between benign and potentially malignant lesions.

• Dr Hazel Serrao-Brown Specialist Peer Review
  All cases are reviewed within a multidisciplinary team, including endocrine surgeons, endocrinologists, and radiologists. This ensures highest standards in determining whether adrenalectomy is the appropriate treatment for you

​Recovery and Aftercare
 
Recovery from adrenal surgery varies depending on the individual and the type of surgery performed. Patients are usually monitored in the hospital for a short period and may require hormone replacement therapy if both adrenal glands are removed. Follow-up appointments are essential to ensure proper recovery and hormone balance.

Surgical Approach
 
Depending on diagnostic results and individual patient factors, Dr Hazel Serrao-Brown may recommend the following surgical procedures:
 
Adrenalectomy is typically performed using a minimally invasive laparoscopic technique, involving small incisions and a camera to guide the surgery. This approach offers benefits like reduced recovery time and minimal scarring. In certain cases, open surgery may be necessary, especially for larger or more complex tumours.
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Retroperitoneal Adrenalectomy

Dr Hazel Serrao-Brown can perform the retroperitoneal adrenalectomy surgical technique where the adrenal gland is accessed through the back, avoiding entry into the abdominal cavity. This approach is particularly advantageous for patients with prior abdominal surgeries, as it reduces the risk of adhesions and complications associated with intra-abdominal procedures.
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Surgical Technique
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• Patient Positioning: The patient is placed in a prone position (lying face down) on the operating table. This positioning provides optimal access to the retroperitoneal space, where the adrenal glands are located.

• Incision Placement: A small incision is made below the 12th rib on the patient's back. This entry point allows the surgeon to access the retroperitoneal space directly.

• Trocar Insertion: Through the incision, a balloon trocar is inserted to create a working space by insufflating the retroperitoneal area. This distension facilitates the introduction of additional trocars for surgical instruments

• Adrenal Gland Removal: Using minimally invasive instruments, Dr Hazel Serrao-Brown carefully dissects and removes the adrenal gland. This method minimizes trauma to surrounding tissues and organs.

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Advantages of the Retroperitoneal Approach
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• Direct Access: Provides a straight path to the adrenal glands, reducing the need for mobilisation of other organs.

• Reduced Risk of Adhesions: By avoiding the abdominal cavity, there's a lower chance of developing adhesions, which can complicate future surgeries.

• Bilateral Surgery: Allows for the possibility of performing bilateral adrenalectomies without repositioning the patient.

• Shorter Recovery Time: Patients often experience less postoperative pain and a quicker return to normal activities compared to traditional open surgery.

Expected Post-Operative Symptoms (Normal)​​
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Following adrenalectomy, most patients recover well, particularly when the procedure is performed by Dr Hazel Serrao-Brown using the minimally invasive (laparoscopic or retroperitoneoscopic) approach. However, some post-operative symptoms are normal and to be expected as part of the healing process.
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Common, Expected Symptoms:

• Mild pain or discomfort around the incision sites, typically managed with relief (oral route)

• Fatigue or tiredness for a few days to a couple of weeks after surgery

• Bruising or swelling at the incision areas

• Shoulder tip pain (especially after laparoscopic surgery), due to residual gas used to inflate the abdomen

• Temporary changes in bowel habits, such as bloating or constipation, often due to pain medications or reduced mobility

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Hormonal Adjustment Symptoms:
If one adrenal gland is removed, the remaining gland usually compensates. However, patients may experience:
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• Mild dizziness or light-headedness, particularly if blood pressure medications need adjusting

• Changes in electrolyte levels, especially potassium or sodium, depending on the underlying condition

• Need for hormone replacement in some cases (especially if both glands are removed or if the remaining gland is under-functioning)