Twitter Surgery
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UAB Medicine is pleased to provide health care professionals, medical students, and the public with an exciting glimpse into the OR with our first live Tweeted surgery. Join UAB surgeon Martin Heslin, MD, Friday, October 23, 8 AM CST, on Twitter at www.uabmedicine.org/twitter for step-by-step tweets of a robotic adrenalectomy.
The Case
Heslin will be performing surgery on a middle-aged man who has severe, longstanding hypertension (high blood pressure) that requires multidrug treatment. His hypertension is aggravated by a small aldosterone-producing tumor. Aldosterone is a hormone involved in blood pressure regulation and when levels are too high hypertension can result. Watch a video about how this patient was diagnosed.
How was the aldosterone-producing tumor diagnosed?
The patient was referred to UAB hypertension specialist and Medical Director of the UAB Hypertension Clinic David A. Calhoun, MD. As part of his examination the patient underwent a computed tomography (CT) scan of the abdomen that revealed a small nodule on his left adrenal gland. Further testing showed he had elevated levels of aldosterone, which causes suppression of renin, an enzyme involved in blood pressure regulation. The results of the CT scan combined with the high level of aldosterone and low level of renin led to the diagnosis of primary aldosteronism. Primary aldosteronism is an increasingly recognized though still under-diagnosed cause of resistant hypertension (diagnosed when patients cannot attain blood pressure goals despite adhering to an appropriate three-drug regimen).
How did the patient and physician decide that a robotic adrenalectomy was the best treatment option?
The treatment of choice for the majority of patients diagnosed with a unilateral (on one side only) aldosterone-producing tumor is an adrenalectomy. Surgeons can perform an adrenalectomy either laparoscopically (the most common approach for the last decade), robotically (as is being done with this patient) or using a traditional open procedure (which is now uncommonly performed). Patients must have two adrenal glands to be candidates for an adrenalectomy. Candidates for a minimally invasive procedure – laparoscopic or robotic – are those who have tumors smaller than 8 cm and who have not had extensive prior surgery in the general area surrounding the adrenal gland. Scar tissue from previous surgeries can create challenges for surgeons, though Heslin notes that an experienced surgeon usually can overcome many of these obstacles and use a minimally invasive approach (laparoscopic or robotic) in most patients.
What is the goal of this procedure?
An adrenalectomy improves blood pressure in almost all patients with an aldosteronoma. For this particular patient the goal is to reduce the number of blood pressure medications he must take, reduce the dosages of those medications, or both. An adrenalectomy can be a surgical cure for hypertension in some patients, particularly those who are younger than 40, have no family history of hypertension, a short duration of hypertension, or who were taking two or fewer blood pressure medications prior to surgery.
