UAB surgeons perform Alabama’s first simultaneous bilateral adrenalectomy

A simultaneous bilateral adrenalectomy removes both adrenal glands at the same time, providing benefits to both the patient and surgeons.

Stream simultaneous bilateral adrenalectomyA simultaneous bilateral adrenalectomy removes both adrenal glands at the same time, providing benefits to both the patient and surgeons.A team of surgeons from the University of Alabama at Birmingham successfully completed a simultaneous bilateral adrenalectomy — the first in the state of Alabama.

A bilateral adrenalectomy removes both adrenal glands and can provide relief to patients who have an excess of the hormone cortisol. Additional cortisol in the body can be caused by a tumor on the pituitary gland. According to Brenessa Lindeman, M.D., associate professor in the UAB Marnix E. Heersink School of Medicine’s Department of Surgery, a bilateral adrenalectomy is considered if the location of the tumor is too dangerous for removal or if a previous pituitary operation was unsuccessful.

“There’s a risk/benefit balance with pursuing a pituitary operation, so our multidisciplinary team of surgeons and endocrinologists evaluate each patient’s case and decide whether removing both of the adrenal glands should be the next step,” she said.

If removing both glands is best, the patient would undergo an adrenalectomy to remove all the adrenal cells to stop the production of cortisol. According to Lindeman, in a standard bilateral adrenalectomy procedure, each of the adrenal glands is removed one at a time, causing the surgeon to complete two meticulous surgeries back to back. 

“Removing the glands one at a time can be very time-consuming because we have to reposition the patient after the first gland is removed before we can move on to the second,” said Lindeman, who is also chief of the section of Endocrine Surgery at UAB. “We have used this approach for years, but the new simultaneous bilateral approach will be beneficial both for our surgeons and for patients.”

With the simultaneous bilateral approach, a retroperitoneoscopic adrenalectomy — accessing the glands through the patient’s back as opposed to through the abdomen — is performed, allowing two surgical teams to access both glands at the same time, without the need to reposition the patient.

“By our operating on both glands at the same time, patients receive the benefit of having their anesthesia time cut in half,” said Jessica Fazendin, M.D., assistant professor of endocrine surgery. “It is also great for the surgeons because you have two sets of eyes in the operating room. If you need an intraoperative consult, your colleague is standing right across from you.”  

Lindeman and a team of surgeons at UAB including Fazendin and Andrea Gillis, M.D., have now completed two simultaneous bilateral adrenalectomy procedures and are integrating the new technique into their standard of care.

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