The advantages of ‘laparoscopic adrenalectomy’

Asian Hospital and Medical Center (AHMC) has broken the barriers for the age of minimally invasive surgery with the inclusion of "laparoscopic adrenalectomy" in its roster of advanced laparoscopic surgical procedures readily available to Filipinos.

Dr. Rolando Mendiola and Dr. Miguel Mendoza, two of AHMC’s laparoscopic surgeons, recently performed a laparoscopic adrenalectomy on a 57-year old woman suffering from persistent hypertension (elevated blood pressure), hypokalemia (decreased body potassium), and generalized body weakness.

After a complete work-up, her blood tests revealed increased production of the hormone known as aldosterone. Magnetic Resonance Imaging (MRI) of her abdomen further showed the presence of an adrenal tumor measuring about 2.2 centimeters, which was the cause of her condition. Although benign, it must be surgically removed in order to treat her symptoms without life-long reliance on medications.

Using the laparoscopic surgery technique on this patient, Mendiola and Mendoza were able to successfully remove the adrenal tumor in less than two and a half hours.

After the surgery, the patient recovered excellently and she was discharged after two days. The blood pressure, potassium and aldosterone levels returned to normal without dependence on previous medication.

The patient is now doing well and was back on her feet in no time.

Laparoscopic surgery embraces the principle of minimally invasive surgery which, in effect, benefits the patient more because of less tissue trauma. It is performed while the patient is under general anesthesia, hence the patient is asleep throughout the procedure.

Around four small incisions approximately one-fourth- to one-half-inch are made on the abdomen after which trocars (narrow tube-like instruments) are inserted through the abdominal wall. The abdomen is insufflated with harmless gas to provide a good working area for the surgeon.

A laparoscope (a tiny telescope) connected to a camera is inserted through the trocar into the abdomen and gives the surgeon a magnified view of the patient’s internal organs on the video monitor. The surgery is performed using long, thin specialized instruments under direct magnified vision.

Benefits

There are many advantages of laparoscopic surgery over the traditional open surgery. These include less hospital stay, faster recovery, quicker resumption of normal activities, earlier return to work, less tissue trauma and post-operative pain, lower dependence on pain relievers, and just a few small scars. What’s more, laparoscopic surgery takes only approximately less than a week for full recovery compared to six to eight weeks in open surgery.

Realizing the fact that advanced laparoscopic surgery may be met with raised eyebrows from other people. Mendiola and Mendoza emphasized that this procedure is a safe technique if performed by properly trained laparoscopic surgeons. Thus, it is imperative for patients to know the credentials of the surgeon who will be performing the surgery.

Mendiola himself has been actively involved in the practice and teaching of laparoscopic surgery in the United States and the Philippines and is currently AHMC’s section head for laparoscopic surgery.

Mendoza, on the other hand, has close to a decade of surgical experience and had his formal clinical fellowship training in advanced minimally invasive and laparoscopic surgery at the world-renowned Michael E. de Bakey Department of Surgery of the Baylor College of Medicine in Houston, Texas.

It is also important for patients to know all the information regarding his disease and all the treatment options that are available. As Mendoza puts it, "Part of an informed consent prior to a surgical procedure is informing the patient of alternative surgical procedures, including laparoscopic surgery or minimally invasive surgery. Failure to present to the patient the options is tantamount to depriving him of the potential benefits he may have."

Apart from adrenalectomy, other procedures that can be done safely and efficiently through laparoscopic surgery are diagnostic abdominal exploration, gallbladder removal, bile duct exploration, inguinal hernia repair, ventral and incisional hernia repair, large bowel resection, spleen removal, anti-reflux surgery, esophageal and gastric surgery, and surgery for the morbidly obese.

For more information on laparoscopic surgery, get in touch with the Laparoscopic Surgery Group at Room 412, Medical Offices bldg., Asian Hospital and Medical Center at 771-9314 or 771-9000 local 8491.