Is the Old-Fashioned Transabdominal Open Adrenal Operation Ever Needed?
Although almost all patients needing adrenal gland surgery should have the Mini Back Scope Adrenalectomy (MBSA), the old-fashioned, open surgery through the front of the abdomen is still occasionally needed (less than 3-5 % of adrenalectomies). In this operation, the surgeon approaches the adrenal glands through a larger incision on the anterior (front) abdominal wall, moving the bowel and other organs out of the way to gain access to the kidney and adrenal glands. This surgical approach is primarily used for very large adrenal tumors (>12 cm) and those adrenal tumors that are suspected or known to be malignant, especially if they are invading surrounding structures such as the kidney, liver, spleen, pancreas, bowel or major vessels such as the inferior vena cava (IVC).It is absolutely crucial that your adrenal surgeon is comfortable with all techniques of adrenal surgery since a customized, individual approach will give the best possible outcome. You need an operation that is tailor-made for you and your tumor.
The other time old-fashioned, open transabdominal operation may be needed is in the rare scenario where the patient has a retroperitoneal paraganglioma. Retroperitoneal paragangliomas are cousin tumors of pheochromocytomas, but can arise anywhere in the abdominal cavity (as opposed to only in the adrenal gland). They are typically located along the greater vessels of the abdomen, meaning the aorta all the way down to the iliac arteries and the urinary bladder. Since these tumors can be intimately involved with the major vessels in your body, open surgery is often required. You can read more about retroperitoneal paragangliomas here.
Do Adrenal Tumors Ever Grow Back?
Removed tissue after an open, old-fashioned reoperation for pheochromocytoma tumor spilled throughout the abdomen (called “pheochromocytomatosis”) at the initial operation 15 years prior at an outside institution. Dr. Carling achieved a curative result. The arrows show the tumor implant in the left adrenal bed, the spleen and omentum.
A particularly challenging group of patients we at the Carling Adrenal Center deal with frequently are patients who have a recurrence (re-growth) of their adrenal tumor. This almost always means that a previous surgeon had attempted to remove the adrenal gland tumor, but did not get all of it--so it grows back some months or years later. This most commonly occurs in the setting of a pheochromocytoma or adrenocortical carcinoma (adrenal cancer). In many of these cases the cancer has grown back because it was not completely or appropriately removed. Naturally the previous operation has caused a significant scar formation. In this scenario, the best option may be to perform an open traditional operation.
The down-sides of the old-fashioned adrenal operation through the abdomen. The major downsides with doing an old-fashioned, open operation is that the operation takes a lot longer time, and the recovery takes much longer. Due to the larger incision, often the patient may have significant pain (requiring an epidural catheter, strong pain medications, etc) which may require the patient to stay in the hospital 3 to 5 days. See our page on the 8 Types of Adrenal Operations to understand more about the pros and cons of each type of adrenal surgery.
Completed resection after an open, old-fashioned reoperation for “pheochromocytomatosis”.
REMEMBER: Adrenal surgery can be performed eight different ways, but the best operation for almost all patients is a mini-back scope operation, the Mini Back Scope Adrenalectomy (MBSA) The specific adrenal surgical technique used will be dictated by the situation at hand. It is crucial that your adrenal surgeon is comfortable with all different techniques so you have the best operation for your specific situation.
Read more about the Mini Back Scope Adrenalectomy (MBSA) on this page. This minimally invasive scope operation is the adrenal operation that about 95% of patients with an adrenal tumor should have.
What do patients worry about when it comes to adrenal gland removal? Read more on our adrenal surgery blog