Laparoscopic Adrenalectomy Is Not Recommended

Laparoscopic adrenalectomy is not recommended for adrenal gland removal, since newer, more modern techniques of adrenal surgery are much faster, better, and safer. Despite this, many patients are only offered laparoscopic adrenalectomy. The reason for this is that their surgeon is inexperienced. The surgeon only performs adrenal surgery rarely and does not know of these more modern, advanced operations. The average number of laparoscopic adrenalectomy cases performed by U.S. adrenal surgeons is 1 (one). Yes, you read that correctly. It is hard to be an expert on something you only do once a year. Do not make the mistake of selecting an inexperienced surgeon.

The best advice is to identify the most experienced adrenal surgeon for your operation. The best adrenal operation is the Mini Back Scope Adrenalectomy (MBSA). 

Watch me perform this procedure in 20-minutes below.

The Top 5 Reasons Laparoscopic Adrenalectomy Should Be Avoided:

1. The operation takes hours instead of minutes.
2. There is more pain.
3. The patient has to stay longer in the hospital with a slower recovery.
4. The surgeon has to deal with scarring from previous operations, making the operation less safe.
5. The operation can cause long-term problems with hernias and bowel obstructions.

Laparoscopic adrenalectomy takes a long time to perform (hours instead of minutes)

Laparoscopic adrenalectomy takes a very long time, hours instead of minutes compared to the Mini-Back Scope Adrenalectomy (MBSA). The reason laparoscopic adrenalectomy takes so much longer time, compared to more modern operations, is that the operation is done through the abdomen (belly). The adrenal glands are located in the very back of the abdomen on top of the kidneys. That means that the surgeon has to move a lot of organs just to get to the adrenal gland.  On the right side the surgeon has to dissect out and move the duodenum, the right colon, the liver, the vena cava, and the right kidney just to get to the adrenal gland. On the left side a similar dissection has to be performed of the spleen, the pancreas, the left kidney, and the left colon. More dissection, and more surgery inevitably leads to more problems, blood loss and complications. Also, longer anesthesia time for the patient leads to anesthesia complications including nausea, vomiting and brain fogginess.

WOW! At Johns Hopkins, a laparoscopic adrenalectomy takes 3-4 hours, and 1/20 of patients lose so much blood that they need a blood transfusion. If laparoscopic adrenalectomy takes 4 hours at Johns Hopkins, how long do you think it takes at your local hospital down the street? How much blood would they lose? Then some surgeon wants to add a robot in the mix (again due to inexperience), and all bets are off. Don’t have adrenal surgery through your belly!

We have never given blood in our entire careers for adrenal surgery, and a Mini-Back Scope Adrenalectomy (MBSA) typically takes 15-25 minutes.

Learn more about what to expect from adrenal gland surgery.

Laparoscopic adrenalectomy is more painful

Laparoscopic adrenalectomy is much more painful than more modern, advanced surgical approaches to adrenal surgery. The reason laparoscopic adrenalectomy is so painful is that the incisions are through the abdomen, and it splits the muscle of the belly. This leads to a lot of pain afterwards. Often patients have to take strong pain medications that contain narcotics. The problem with these medications is that not only can they cause dependency, but they also slow down the bowel function leading to a higher rate of constipation. Not surprisingly, if you have constipation after an operation this will create even more pain.

The best option is to have an operation of the adrenal gland that does not require strong pain medication, only over-the-counter Tylenol, and ibuprofen. This type of pain medications does not have the same negative effects on the bowels and do not lead to constipation.

The patient has to stay in the hospital longer and have a slower recovery after laparoscopic adrenalectomy

Patients undergoing laparoscopic adrenalectomy have a longer hospital stay and a longer time until recovery. Again, this is related to the more extensive surgery and the incision being made on the front, through the belly. The dissection associated with laparoscopic adrenalectomy leads to more inflammation, pain and a resulting longer hospital stay. It is not uncommon for patients to have to stay twice as long in the hospital after laparoscopic adrenalectomy compared to the Mini Back Scope Adrenalectomy (MBSA). In addition, it takes longer to return to normal activities such as walking, running, playing tennis and golf, skiing, and other physical activities.

During laparoscopic adrenalectomy, the surgeon has to deal with scarring from a previous operation on the abdomen, which can be unsafe

Many patients have had previous operations on their abdomen. This can have been performed because of bariatric surgery (gastric band, sleeve gastrectomy, gastric bypass), surgery of the gallbladder (cholecystectomy), liver, pancreas, stomach, bowel (colectomy, appendectomy) or any previous kind of gynecological operation (Caesarian section, hysterectomy).  What all these operations have in common is that they cause scar tissue in the abdomen. Adhesions are scar tissue that form just from touching and manipulating the bowel, meaning the small and large intestine. Any subsequent operation has to deal with all this scar tissue if you go through the belly. This makes the operation less safe and there is always a risk of causing an injury to the bowel or a perforation of the bowel. Leakage of bowel contents into the abdominal cavity can have catastrophic results if it is not immediately detected.

Laparoscopic adrenalectomy in a patient who has had previous abdominal surgery is not recommended. It is it is much better to perform the Mini Back Scope Adrenalectomy (MBSA) through incisions in the back where the surgeon does not have to deal with all the scar formation from the previous operations.

Hernias and bowel obstructions can happen after laparoscopic adrenalectomy

Laparoscopic adrenalectomy is also not recommended because it can cause long-term problems with complications such as hernias and bowel obstructions. A hernia is when there is a defect in the abdominal wall. After any operation going through the belly there can be a hernia, meaning a defect of the abdominal wall, that does not heal up properly. This is what is called a hernia. A hernia can cause bowel to get trapped which leads to a bowel obstruction. It is usually the small bowel that gets trapped in these hernias and cause bowel obstruction. A bowel obstruction can make a patient very sick with vomiting and inability to pass gas or bowel movements. Sometimes extensive surgery is needed to treat a bowel obstruction.

Having a more modern operation going through the back does not lead to any of these complications since the operation is designed in such a way where the bowels are not even touched or manipulated. The whole operation is performed behind the abdominal cavity in what is called the retroperitoneum.

Read more about the top patients worries concerning adrenal gland surgery. 

Additional Resources: 

Learn more about the Carling Adrenal Center

Learn more about Dr. Tobias Carling

Learn more about our sister surgeons at the Norman Parathyroid Center, Clayman Thyroid Center and Scarless Thyroid Surgery Center