How is Adrenal Surgery Performed?

Adrenal surgery can be performed eight different ways. The specific adrenal surgical technique used will be dictated by the situation at hand. It is crucial that your adrenal surgeon is comfortable with all different techniques of adrenal surgery since a customized, individual approach will give the best possible outcome. Adrenal surgery should be tailor-made for you and your specific tumor.

Almost all adrenal tumors (>95%) can now be removed using minimally invasive techniques such as the Mini Back Scope Scope Adrenalectomy (MBSA). This operation is also called "Posterior Retroperitoneoscopic Adrenalectomy". In fewer than 5% of patients needing adrenal surgery, laparoscopic transabdominal adrenalectomy (LTA), with or without a hand-port is used, but typically only when the adrenal tumor is more than 8 cm (3 inches) in diameter.

The very small incisions below the 11th and 12th rib of the back used for successful Mini Back Scope Adrenalectomy (MBSA) The very small incisions below the 11th and 12th rib of the back used for successful Mini Back Scope Adrenalectomy (MBSA). Large tumors (>12 cm) and tumors that are suspected to be malignant, 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. Rather an open standard adrenalectomy technique is required.

It should be noted that very few surgeons in the world have significant experience with all eight techniques and understand the subtle pros and cons of each approach. This is why you need to identify the most experienced adrenal surgeon possible. The adrenal surgeons of the Carling Adrenal Center have the most experience in the world and perform operations on people from all over the world every week.


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What Kind of Surgeons Perform Adrenal Surgery?

Adrenal surgery is performed by general surgeons, endocrine surgeons and urologists. Experience of the surgeon in adrenal operations is by far the most important criteria. It is well known that surgeons who perform many adrenalectomies (removal of adrenal gland) perform the operation much faster, much more safely, have fewer complications and the patients do better postoperatively.

The bad news about adrenal surgery. Unfortunately, 90% of adrenal operations in the United States are performed by surgeons who only do 4 or fewer per year (yes, four or fewer). In fact, the bad news is that the median (average) number of adrenal operations performed by surgeons in the Unites States is 1 (one)! That's right, most adrenal operations are performed by surgeons who only do ONE of these operations per year and the outcomes are not nearly as good as they could be. This is a huge problem for patients. Very few surgeons have any meaningful experience performing adrenal surgery. One of the reasons is that many different types of surgeons do very low volumes of adrenal operations. Endocrine surgeons (those specializing on 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 in your area. We perform more adrenal operations than any hospital or university in the world, and more than 10 times more than any other center in the US.

The following doctors are known to occasionally perform adrenal surgery:

  • Endocrine surgeons
  • Minimally Invasive (bariatric, weight loss, hernia) surgeons
  • General surgeons
  • Surgical Oncologists (also operate on breast, melanoma, intestine, liver, pancreas, etc)
  • Urologists (treat urinary infections, kidney stones, tumors of the bladder, prostate, kidney, etc)

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What You Need to Know in One Sentence

If you need adrenal surgery, the best operation for almost everybody is 1) a minimally invasive SCOPE operation, 2) the scopes go through the patient's lower BACK and NOT through the patient's front abdomen... a "Mini Back Scope Adrenalectomy; MBSA", and 3) have it performed by an expert.

Listen to the Podcast of Dr Carling discussing adrenal surgery. Remember, the Mini Back Scope Adrenalectomy; MBSA is the best operation for 95% of patients who need adrenal surgery. It is also the preferred technique for the partial (or cortical-sparing) adrenalectomy which you should read about if you need adrenal surgery on both adrenal glands. Note that we have more in-depth information about the 8 Different Types of Adrenal Surgery that are possible on another page.

Listen to a podcast of Dr Carling discussing many aspects of adrenal surgery.