What is the Best Adrenal Gland Operation for Adrenal Tumors?

The Mini Posterior Retroperitoneoscopic Adrenalectomy 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 Adrenal Operation, or simply, MBSA.

The correct prone position of a patient undergoing a left Mini Back Scope Adrenalectomy (MBSA). The correct prone position of a patient undergoing a left Mini Back Scope Adrenalectomy (MBSA). This operation was performed for an 1.2 cm aldosterone-producing adrenal tumor causing primary hyperaldosteronism (Conn’s syndrome) and was completed in 23 minutes by Dr. Carling. 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 (fiberoptic camera) via three small incisions in the 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 a small scope nd fine endoscopic instruments makes total sense and has many tremendous benefits--but few surgeons know how to do it. It is not taught in surgical 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 Adrenalectomy (MBSA)

By going through the sides of the back the surgeon has a very direct approach to the adrenal gland with the Mini Back Scope Adrenalectomy (MBSA). 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 a decade on hundreds of patients. Note that this is a very advanced technique--surgeons that operate on adrenal glands only 4 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 Retroperitoneoscopic Adrenalectomy", so we often just call it the MBSA, or the "Mini Back Scope Adrenal Operation" since it describes the operation pretty well: a minimally invasive technique using a very small scope and fine instruments that go through the lower back to get the adrenal tumor out. There is no question this is the best adrenal operation for almost everybody. We have another page that discusses the benefits of the Mini Back Scope Adrenalectomy (MBSA) and what makes it far superior to all other adrenal operations for almost everybody.

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 Back Scope Adrenalectomy (MBSA) is done, in experienced hands, should have near zero blood loss and is, by far, the best adrenal operation available anywhere in the world. Do not fall for the "Robot" surgery gimmicks--it isn't better and is far worse in almost every instance when operating on the adrenal. Yes, it's good for the prostate, but not the adrenal! The other advantages of the Mini Back Scope Adrenalectomy (MBSA) 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 includes the robotic adrenal operations). All these factors lead to less pain for the patient with a shorter length of stay, faster recovery return to normal activities and work. The advantage of less manipulation of the bowel, spleen, stomach, pancreas and other abdominal organs leads to reduced risk of injury to the surrounding organs and major vessels.

It takes Dr. Carling on average about 35 minutes to perform a Mini Back Scope Adrenalectomy (MBSA). And he performs several per day, not per year.

Dr. Carling focuses during a Mini Back Scope Adrenalectomy (MBSA). Dr. Carling focuses during a Mini Back Scope Adrenalectomy (MBSA).

Patients who had abdominal surgery in the past and bilateral tumors. The Mini Back Scope Adrenalectomy (MBSA) is particularly helpful in patients that have had previous abdominal operations or have bilateral adrenal tumors. IMPORTANT. If you have ever had an operation on your abdomen, for instance, 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 operation (C-section, hysterectomy, etc), it is likely you have abdominal scar tissue (called "adhesions"). Performing another transabdominal operation subjects you to increased risk of injury to bowel, and other organs. You would very much benefit from having an operation through the back. That is, the Mini Back Scope Adrenalectomy (MBSA). Dr. Carling does not even enter into the abdomen. The whole operation is performed in the retroperitoneal space, and there is no scar tissue here from previous operations. This make your operation much safer and faster, and prevents future problems with bowel blockage (obstruction). Moreover, 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. With the LTA approach, the patient is in a lateral position (on their side) surgeons have to flip the patient between performing the left and right adrenalectomy. The Mini Back Scope Adrenalectomy (MBSA) simply allows the surgeon to move from one side of the operating room table to the other side without moving the patient. Again, it is very important that you have a very experienced adrenal surgeon--not somebody that does gallbladders, kidney operations, obesity surgery and hernias.

A fast operations is almost always the best operation. 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 Back Scope Adrenalectomy (MBSA) 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 anesthesia, the greater risk of anesthesia-related complications such as nausea, vomiting, headache, and in some cases long-term effects on cognition, concentration and memory. Suffice to say, the shorter the time you can be under general anesthesia, the better it is for you.

What are some of the things you should know about adrenal gland surgery? Read more on our adrenal surgery blog

The view of the retroperitoneal space during left Mini Back Scope Adrenalectomy (MBSA). K = kidney, A = adrenal, AV = left adrenal vein and artery The view of the retroperitoneal space during a left Mini Back Scope Adrenalectomy (MBSA). K = kidney, A = adrenal, AV = left adrenal vein and artery. As you can see from the figures and operative videos we have on this website, as soon as the surgeon enters into the retroperitoneum (back) 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 hidden on the sides of the lower back.The cosmetic outcome is exceptional after Mini Back Scope Adrenalectomy (MBSA). 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 operation (C-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 painful and dangerous small bowel obstruction. Another advantage with this technique is that it reduces the risk of postoperative, incisional hernia formation. The cosmetic outcome of Mini Back Scope Adrenalectomy (MBSA) is exceptional.

The 20 minute Mini Back Scope Adrenalectomy (MBSA): Webinar with Dr. Friedman and Dr. Carling

Small Steri-strips (Band-Aids) after Right Mini Back Scope Adrenalectomy; MBSA Small Steri-strips (Band-Aids) after Right Mini Back Scope Adrenalectomy; MBSA If you came this far and you or somebody you know needs an adrenal operation, the next pages for you to read are:

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Patients needing adrenal surgery travel from all over the world to have adrenal surgery with Dr. Carling, the most experienced adrenal surgeon. This page discusses how you can have your adrenal operation at the Carling Adrenal Center with Dr. Carling himself.

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