Surgical Procedures

Our surgeons perform specialized surgery to precisely and safely remove adrenal tumors. At Columbia, surgeons perform 95 percent of adrenalectomies by laparoscopy. Laparoscopy significantly reduces discomfort, speeds healing, and leaves only tiny scars behind. After laparoscopic adrenalectomy, the majority of patients are able to leave the hospital within a day or two of the operation.

Operative Approaches to The Adrenal Gland

There are five operative approaches to the adrenal glands. The type of approach chosen by your surgeon is influenced by:

the size and type of the tumor,
its appearance on imaging studies (CT or MRI), and
whether the patient has had prior abdominal surgery.

Most adrenal tumors can be removed laparoscopically, a minimally invasive approach that is performed by inserting a camera through several very small incisions. Large tumors (>10 cm) and tumors suspected of being malignant may require open surgery through a traditional incision.

Laparoscopic Adrenalectomy

Columbia Adrenal Center surgeons remove the vast majority of adrenal tumors laparoscopically. In a laparoscopic adrenalectomy, the adrenal gland is removed through several very small incisions (each less than half an inch) using special instruments. The abdomen is filled with gas (carbon dioxide) to provide exposure, and visualization is achieved by placing a small camera into the abdomen with the image projected onto a TV screen. The laparoscopic approach offers the shortest recovery time and the least amount of postoperative pain. Most patients may leave the hospital within a day or two of the operation. This approach can be used for tumors less than 10 cm in size, and for tumors that secrete hormones (including pheochromocytomas). The laparoscopic adrenalectomy is the technique of choice for most adrenal operations. Our surgeons perform two types of laparoscopic adrenalectomy and tailor the operation to the type of tumor and the patient's preferences:

Laparoscopic transabdominal approach: uses 3 or 4 very small incisions in the abdomen placed just below the ribcage to approach the adrenal gland through the abdominal cavity. This is an excellent approach for tumors of all types and sizes.
Laparoscopic retroperitoneal approach: uses 3 very small incisions in the back placed just below the ribcage to approach the adrenal gland from outside the abdominal cavity. This is an excellent approach for smaller tumors and especially for patients who have had previous abdominal surgery. Previous abdominal surgery can lead to scarring inside the abdomen (or adhesions) that may make another operation in the abdomen more difficult. The laparoscopic retroperitoneal approach avoids this scar tissue by allowing the surgeon to stay outside of the abdomen altogether. This is an advanced technique that is only offered at a few select institutions throughout the world.

Open Adrenalectomy

Open adrenalectomy is typically reserved for patients with very large tumors (over 10-15 centimeters) or in whom a primary adrenal cancer is suspected. Patients undergoing open adrenalectomy often remain in the hospital for a few days after the operation. Depending on the size and type of tumor, there are 4 types of open operations:

Trans-Abdominal Approach: uses either a vertical incision in the midline of the abdomen or an incision underneath one side of the ribcage. This approach has the advantage of giving the surgeon access to both adrenal glands through one incision as well as excellent exposure of the large blood vessels near the adrenals.
Thoraco-Abdominal Approach: uses a large incision extending through the chest, the abdomen, and the diaphragm, providing wide exposure of the area. Although invasive, this approach is chosen for large malignant tumors when the surgeon needs maximum exposure to perform an adequate resection.
Posterior Approach: uses a small incision in the back, directly over the adrenal gland. While the exposure of the gland is limited, the postoperative recovery process is much faster versus other open surgical approaches. Small benign tumors are particularly amenable to this type of access. The posterior approach has largely been replaced by the laparoscopic approach, which further improves the pace of postoperative recovery.
Retroperitoneal Approach: uses an incision below the 11th rib, part of which is removed at the time of surgery. This flank incision provides excellent exposure without violating the abdominal or chest cavities. Patients typically have less pain and a faster recovery than can be achieved through the trans-abdominal or thoraco-abdominal approach. Like the posterior approach, this technique has largely been replaced by the laparoscopic approach.