Minimally Invasive Posterior Adrenalectomy: New Approach Offers Multiple Benefits

by Steven Hochwald, MD
Chief of Gastrointestinal Surgery
Vice Chair of Department of Surgical Oncology
Professor of Oncology

There are several ways to remove the adrenal gland. For many years the minimally invasive transperitoneal approach has been the preferred technique and is now used more than any other. Yet it has limitations, including painful and unsightly incisions on the anterior abdominal wall. In addition, access to the adrenal gland can be difficult and requires mobilization of the liver for right-side tumors and mobilization of the pancreas, spleen and colon for left-side tumors. This can increase the risk of complications and prolong surgery.

Recently a new method has been introduced, and it is now used routinely by surgical oncologists at Roswell Park Cancer Institute for adrenal gland removal through posteriorly placed, minimally invasive incisions on the back. We use the technique for many types of adrenal tumors, including those that produce excess hormones; enlarged tumors; or cancerous masses that may have spread to the adrenal gland from other organs — for example, the lung or colon.

Typically only three small incisions are needed, and ,surgical time is approximately 60–90 minutes. Often patients stay in the hospital for just one or two days after the procedure.

Performing adrenal gland removal through small back incisions offers significant benefits over surgical removal through the abdomen. Because the adrenal glands are found right above each kidney, it is not necessary to move any organs out of the way, such as the spleen, liver, pancreas and colon. There are fewer risks, and the patient experiences minimal scarring, less postoperative pain and faster recovery.