How is Adrenal Surgery Performed?
Adrenal surgery can be performed eight different ways. The technique used depends on the situation at hand. It is crucial that your adrenal surgeon is comfortable with all the different techniques, since a customized, individual approach gives the best possible outcome. Adrenal surgery should be tailor-made for you and your specific tumor.
Almost all adrenal tumors can be removed with minimally invasive (scope) techniques. At our center, more than 95% of operations are performed with the Mini Back Scope Adrenalectomy (MBSA). This operation is also called "posterior retroperitoneoscopic adrenalectomy". Across the United States and worldwide, the most commonly performed operation is laparoscopic transabdominal adrenalectomy (LTA), which reaches the adrenal gland through the front or side of the abdomen. Published comparisons favor the back approach for operating time, pain after surgery and length of hospital stay, with similar complication rates. A laparoscopic adrenalectomy through the abdomen typically takes 2 to 4 hours and a robotic adrenalectomy 3 to 5 hours, compared with about 20 minutes for an MBSA. We use the transabdominal approach, with or without a hand-port, in a small minority of patients, typically those with very large tumors.
The back approach has limits. The patient lies face down (prone) during the operation, which does not suit everyone. Body build matters: the distance from the skin to the adrenal gland is more important than body mass index (BMI). Very large tumors and known adrenal cancers may need a different approach.
The very small incisions below the 11th and 12th rib of the back used for successful Mini Back Scope Adrenalectomy (MBSA).
Very large tumors and tumors that are known or suspected to be adrenal cancer, especially if they are invading surrounding structures such as the kidney, liver, spleen, pancreas, bowel, or major vessels such as the inferior vena cava, are almost never removed by minimally invasive operations using scopes. For these, open adrenalectomy remains the standard operation.
Very few surgeons have significant experience with all eight techniques and understand the subtle pros and cons of each approach. This is why you should look for an experienced, high-volume adrenal surgeon. Dr. Carling of the Carling Adrenal Center is one of the world's most experienced adrenal surgeons, having performed thousands of adrenal operations over his career, including more than 2,400 since January 2022 alone. About half of our patients come from outside Florida, including from around the world.
What Kind of Surgeons Perform Adrenal Surgery?
Adrenal surgery is performed by general surgeons, endocrine surgeons and urologists. The surgeon's experience with adrenal operations is by far the most important criterion. Surgeons who perform many adrenalectomies (removal of the adrenal gland) have fewer complications, and their patients do better after the operation.The bad news about adrenal surgery. The typical surgeon who performs adrenal surgery does about one adrenal operation per year. More than 80% of adrenalectomies in the United States are performed by low-volume surgeons, and outcomes are better with surgeons who do the operation regularly. One of the reasons is that adrenal operations are spread thinly across many different types of surgeons. Endocrine surgeons (those specializing in adrenal, parathyroid and thyroid disease) tend to have the most experience. We realize we cannot operate on every patient, but you should identify the highest-volume adrenal surgeon available to you. The Carling Adrenal Center is one of the highest-volume adrenal surgery centers in the world, performing up to 750 adrenal operations a year, about one in eight adrenalectomies in the United States.
The following doctors perform adrenal surgery, most of them only occasionally:
- Endocrine surgeons
- Minimally invasive surgeons
- General surgeons
- Surgical oncologists
- Urologists
Read more about how to choose an adrenal surgeon. What do patients worry about when it comes to adrenal gland removal? Read more on our adrenal surgery blog
Remember, in our experience the Mini Back Scope Adrenalectomy; MBSA is the best operation for most patients who need adrenal surgery. It is also our preferred technique for adrenal-sparing (partial) adrenalectomy, which you should read about if you have tumors in both adrenal glands, a hereditary condition or only one remaining adrenal gland. We have more in-depth information about the 8 Different Types of Adrenal Surgery on another page.
Listen to the podcast of Dr. Carling discussing adrenal surgery.
Listen to a podcast of Dr. Carling discussing many aspects of adrenal surgery.
Last updated October 2026.