What is the Best Adrenal Operation for Conn's Syndrome Tumors?Without a doubt, the best operation for removing the adrenal tumor that is causing hyperaldosteronism and Conn's syndrome is the Mini-Posterior Retroperitoneal Scope Adrenalectomy (Mini-PRSA)" We also refer to this operation as a "Mini posterior adrenal scope operation", or a "back scope adrenal operation" because the operation is perfomed with very small scopes that go through the lower, outer back.
The Mini-PRSA operation ("back scope" adrenal operation) is the preferred technique in over 95% of adrenal surgery cases, and close to 100% in patients with primary hyperaldosteronism. There are many reasons this technique is preferred over any of the other techniques. The operation is performed with a scope and three small incisions at the small of the back of the patients. The cosmetic outcome is exceptional. This gives you a very direct approach to the adrenal gland via the Posterior Retroperitoneoscopic Adrenalectomy (PRA). The surgeons of the Carling adrenal center popularized this technique and have been using this operative approach for more than 10 years and have more experienced than any other center in the United States.
How is a Poserior Scope Adrenal Surgery Performed? The way the operation is done, in experienced hands, leads to no blood loss. The other advantages include that it is faster with less mobilization doing the operation. 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 mobilization 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; IVC.
Dr Carling's Experience with Conn's Syndrome Surgery. It is believed that Dr Carling has performed more Mini-Posteior Retroperitoneal Scope Adrenalectomy, (Mini-RPSA; mini-back scope) operations for adrenal tumors than any other surgeon in the world. When performed for hyperaldosertonism (Conn's Syndrome) this operation typically takes Dr Carling less than 30-45 minutes.
What are the Benefits of Surgery for Conn's Syndrome and Conn's Tumors?There are many benefits from having surgery for Conn's Syndrome and having the adrenal tumor removed. After adrenalectomy (removal of the adrenal gland that has the aldosterone-producing tumor), the patient's high blood pressue is cured (i.e. no more blood pressure medications) in around 50% of patients. The other half of patients will have a significant improvement in their high blood pressuer and reduction of the blood pressure levels as well as the number of blood pressure drugs they need to take. Factors that have been reported to predict cure after adrenalectomy are: response to spironolactone therapy, young age, short duration of high blood pressure, family history of hypertension, preoperative use of fewer antihypertensive agents, higher ARR and 24-h urinary aldosterone levels.
Adrenalectomy leads to improved quality of life and is significantly less costly than treating with medications (cost saving of >$20,000 per patient). Medical treatment is the first choice for PA patients with bilateral disease; however, emerging data suggest that carefully selected patients may better off with surgery.