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-Posterior Retroperitoneal Scope Adrenalectomy (PRSA). We just call this a "Mini-Back-Scope Adrenal Operation". In less than 5% of patients needing adrenal surgery, the Laparoscopic Trans-Abdominal Adrenalectomy (LTA) approach, with or without the hand-port is used, but typically only when the adrenal tumor is more than 5 cm (2 inches) in diameter.

Large tumors (>12 cm) and tumors which are suspected or known 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 technique is required.

It should be noted that very few surgeons in the world have significant experience with all the various techniques and understand the subtle pros and cons with 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 is by far the most important decision you can make. It is well known that surgeons who perform many adrenalectomies (removal of adrenal gland) perform the operation much faster, much safer, have less complications, and the patients do better postoperatively.

The bad news about adrenal surgery. Unfortunately, 90% of adrenal operations in the US 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 surgeries being 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 many 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-volume adrenal surgery. 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 U.S..

The following doctors are known to occasionally perform adrenal surgery

  • Endocrine surgeons
  • Minimally Invasive (Bariatric, weight loss) surgeons
  • Surgical Oncologists (also operate on breast, melanoma, intestine, liver, pancreas, etc)
  • Urologists

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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 patients front abdomen... a "Mini-Back-Scope-Operation", and 3) have it performed by an expert.

Listen to the Podcast of Dr Carling discussing adrenal surgery. Remember, the Mini Posterior Retroperitoneal Scope Adrenalectomy (Mini-PRSA) or "Mini-Back Scope Adrenal Operation" 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 that 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.