What is the Best Adrenal Gland Operation for Adrenal Tumors?
The Mini Posterior Retroperitoneal Scope Adrenalectomy (Mini-PRSA) is the preferred adrenal surgery for >95 % of adrenal tumors. Since this can be hard to say, our patients typically call it the Mini-Back-Scope-Operation. There are many reasons this minimally invasive technique is preferred over any of the other adrenal operations that can be done. The operation is performed with a scope and three small incisions lower part of the back of the patient. Since the adrenal glands are in the very back part of your abdomen, behind all the other organs, getting to them through the back with small scopes makes total sense and has many tremendous benefits--but few surgeons know how to do this--it is not taught in residency because no surgeons see enough cases of adrenal surgery to learn it.
Did you know that 90% of adrenal surgery is performed by surgeons who do 4 or fewer adrenal operations per year? Folks, why are you letting non experts operate on you? The results are not nearly as good and most of you are not getting the best operation for your situation.
The Advantages of the Mini-Back-Scope Adrenal OperationBy going through the sides of the back the surgeon has a very direct approach to the adrenal gland with the Mini-PRSA (mini-back scope). Dr Carling popularized this technique while he was Chief of Endocrine Surgery at Yale University Medical School and has been using this operative approach for close to a decade on thousands of patients. Note that this is a very advanced technique--surgeons that operate on adrenal glands only 5 times per year are not going to offer you this operation so be careful. If your surgeon is going to operate through the front of the abdomen to get to the adrenal gland located in the very back, and you don't have a large adrenal cancer (which is quite rare), then get a second opinion and find a surgeon that does lots of these--your local surgeon does not.
Like you, we find it cumbersome to say "Mini-Posterior Retroperitoneal Scope Adrenalectomy", so we often just call it the Mini-PRSA, or the "Mini-Back-Scope Adrenal Operation" since it describes the operation pretty easily: minimally invasive techniques using very small scopes that go through the lower back to get the adrenal tumor out. There is no question this is the best adreanal operation for almost everybody. We have another page that discusses the benefits of the Mini-PRSA (Mini-Back Scope Operation) and what makes it far superior to all other adrenal operations for almost everybody.
Figure 7-13: The operative approach of the Posterior Retroperitoneoscopic Adrenalectomy (PRA).
What is the Safest Adrenal Gland Operation?The safety of any adrenal operation is dependent upon the skill and EXPERIENCE of the surgeon doing the operation. The way the Mini-PRSA operation is done, in experienced hands, should have near zero blood loss and is hands down the best adrenal operation available anywhere in the world. Do not fall for the "Robot" surgery gimics--it isn't better and is far worse in almost every instance when operating on the adrenal (yes it's good for prostate, but not adrenal!). The other advantages of the "Mini-Back-Scope" operation include that it is faster and leads to less manipulation of the abdominal organs during the operation which is absolutely required for any operation going through the front of the abdomen (which indludes all robot adrenal operations). All these factors lead to less pain for the patient with a shorter length of stay, faster recovery, faster return to normal activities and work. The advantage of less manipulation of the bowel, spleen, stomach, pancreas and other abdominal organs means that there is less risk of injury to surrounding structures such as the such as the kidney, liver, spleen, pancreas, bowel, or major vessels such as the inferior vena cava.
It takes Dr Carling on average about 35 minutes total time to perform a Mini-PRSA (Mini-Back-Scope-Operation). And he performs several per day, not per year.
Patients who had abdominal surgery in the past. The Mini Posterior Retroperitoneal Scope Adrenalectomy (Mini-PRSA) is particularly helpful in patients that have had previous abdominal operations or have bilateral adrenal tumors. With the traditional laparoscopic transabdominal adrenalectomy (LTA) going through the front of the abdomen the patient has to be manipulated during the operation and flipped from side to side. The LTA approach with the patient in a lateral position we would in the past have to flip the patient between performing the left and right adrenalectomy. The Mini Posterior Retroperitoneal Scope Adrenalectomy (Mini PRSA) simply allows the surgeon to move from one side of the operating room table to the other side. Again, it is very important that you have a very experienced adrenal surgeon--not somebody that does gallbladders, kidney operations, obesity surgery, and hernias.
Fast operations are almost always the best operations. How fast the operation is performed is not important if the patient doesn't do well. But surgeons who perform any operation hundreds or thousands of times will perform that operation faster--which means things are going well, there are no surprises, and the patient can be expected to do better. Since the Mini-PRSA operation is faster than any other adrenal surgery techniques, it leads to a shorter time that the patient undergoes general anesthesia. Although, general anesthesia is very safe, the longer time the patient is under general anesthesia, the greater risk of anesthesia-related complications such as nausea, vomiting, neurocognitive symptoms and in some cases long-term effects on cognition and memory. Suffice to say, that shorter a time you can be under general anesthesia the better it is for you.
As you can see from the figures and operative videos we have on the website, as soon as the surgeon enters into the retroperitoneum it allows him/her direct access to the adrenal gland. This makes the mobilization of other structures less extensive. This leads to shorter operative times, less blood loss, less postoperative pain and shorter length of hospital stay.
The Scar is the smallest and hiden on the sides of the lower back.The cosmetic outcome is exceptional after Mini-Posterior Retroperitoneal Scope Adrenalectomy (Mini-PRSA). This approach is especially great if the patient has had any previous operations, such as bariatric surgery (gastric band, sleeve gastrectomy, gastric bypass), gallbladder surgery (cholecystectomy), liver surgery, stomach surgery, bowel surgery of any kind (colectomy, appendectomy, etc) or any previous kind of gynecological operations (Caesarian section, hysterectomy, etc) Additionally, since the whole operation is performed behind the abdominal cavity (retroperitoneum) there is no formation of intra-abdominal scar tissue that can cause small bowel obstruction. Another advantage with this technique is that it reduces the risk of postoperative, incisional hernia formation.The cosmetic outcome of Mini-Posterior Retroperitoneal Scope Adrenalectomy (Mini-PRSA) is exceptional.
If you came this far and somebody you know needs an adrenal operation, the next pages for you to read are:
- All the benefits of the mini-back scope adrenalectomy and why it is the best adrenal operation for 95% of people with adrenal tumors.
- How to become our patient and have Dr Carling perform your adrenal operation.