If you are like me, for every family trip, or big purchase, or need around the house, I perform research.  I cross reference this website with that website. I read the expert and consumer reviews, and sometimes, get three or more quotes to figure out who will provide me the best quality for the best value.  I talk with trusted friends and get their advice.  Why would your health, and more specifically, choosing your surgeon for adrenal gland removal, be any different? 

Here are The Top 4 Things to Do When Choosing Your Surgeon for Adrenal Gland Removal:

• Research and write down questions for your adrenal surgeon
• Understand that experience is the most important factor in picking the best surgeon
• Have a consultation with your top choice for adrenal surgeon and ask hard questions
• Talk to your trusted friends and family to discuss your choice

1) Research and write down questions for your adrenal gland surgeon

There are several websites and blogs discussing adrenal gland removal.  Determine the source of the information and make sure it is coming from an experienced surgeon and reputable center.  Digest the information at your leisure.  Since there is so much information, and sometimes it may seem as if it is written in another language, it may be helpful to pick a date, let’s say 2 weeks into the future, when you will no longer research and put your new-found knowledge into an action plan.  Choosing the best adrenal surgeon for your adrenal gland removal really comes down to experience and mastery of the operation.

Example Questions for your Adrenal Surgeon:

Does your potential adrenal surgeon have the knowledge and experience to best guide you on the options available to you?  Does your surgeon perform all types of adrenal surgery, including the mini-back scope adrenalectomy?  Is your adrenal gland surgeon able to tailor the approach to your adrenal gland removal to your unique anatomy, physiology, and disease process?  Does your surgeon have the expertise and team in-place to set you up for success during and after your adrenal gland surgery? Remember, the typical number of adrenal operations being performed by surgeons in the United States is one per year. Trust me, you do not want to be operated on by a surgeon who performs only one of these cases per year. This means that most people with an adrenal tumor will need to travel to another city or state for the best surgical care and the best outcome.

2) Understand that experience is the most important factor in picking the best adrenal surgeon

Picking the best surgeon for you can sometimes boil down to scheduling around your work or family obligations. We say this because there are very few expert adrenal surgeons which means almost everybody will have to travel for the best care.  Sometimes this life-or-death decision about who will operate on you can come down to whichever surgeon your doctor refers to and is in your insurance network. 

We challenge you to think about this differently.  The most important thing for you to understand when picking the best surgeon is that not all surgeons are created equally.  Sure, you can line-up two surgeons and their respective credentials side-by-side and say, “Well, I recognize this surgeon’s school to be more reputable over this other surgeon’s school,” and come to your decision as to who you trust for your adrenal gland removal that way.  Or you can understand that no pedigree or diploma equates to experience, which is the most important thing in picking the best surgeon for you.

Experience in Adrenal Surgery is Everything.

Experience for all surgery is most important, but even more so for adrenal surgery because it is not performed very often. Experience is so important that surgeons have studied and published major medical research on this, making substantiated claims as to how many adrenal gland removals make a surgeon a “high-volume” adrenal gland surgeon.  Why is this distinction between “high” and “low” volume important?  The studies show that more experience = less complications and better outcomes.  So again, challenge yourself to think about what is most important.  Is it most important for your surgeon to be down the street, even though he/she performs 5-6 adrenal gland removals in one year; or is it most important to find the most experienced surgeon for your adrenal gland removal, someone who has dedicated his life to the understanding of adrenal disease and performs 5-6 adrenal gland removals in a single day?  It is pretty powerful to think about this question in this way, and really emphasizes the point that experience counts.

Adrenal Operations and Adrenal Surgeons are not Created Equal

In going back to the idea that not all adrenal gland surgeons are created equally, there may be several types of doctors that “dabble in” adrenal gland surgery in your community and relish the opportunity to gain experience in this “interesting surgery with intricate physiology.”  Further, adrenal disorders are diagnosed less commonly than let’s say parathyroid or thyroid disorders, and thus, there are less opportunities for your local community or academic surgeon to gain experience in adrenal gland removal. 

Adrenal surgery is analogous to any supply and demand scenario.  The demand for adrenal gland removal in your community is low (due to underdiagnosis—very few of these operations are being performed at any local hospital every year).  The supply of surgeons performing (or wishing to perform) adrenal gland removal is high because the operation is interesting and the hormone disease is challenging. There are lots of surgeons who want to perform adrenal surgery because of these reasons, including: general surgeons, endocrine surgeons, surgical oncologists, minimally invasive surgeons, weight-loss surgeons, and urologists, or kidney surgeons).  So, when your adrenal gland needs to be removed, your primary doctor or endocrinologist may refer you to one of the above types of surgeons that dabble in adrenal surgery. This is almost always not in your best interest.

Since the pie is split-up among too many surgeons at the table, there is a likelihood that “your doctor’s surgeon” does not have extensive experience in adrenal gland removal.  An alternative, and something that you as the consumer may be hungry for, is understanding that you do not have to settle for a referral bias.  You have a choice, and oftentimes, just knowing this is empowering and allows you to ask the best questions to find the best surgeon for you.  This choice may have you searching outside of your local community.  There is something out there called medical tourism, or destination surgery, where those needing a specialized operation will travel to the world’s experts, realizing that their surgeon’s experience is most important when choosing an adrenal gland surgeon.

3) Have a consultation with your top-choice surgeon for adrenal gland removal

I don’t know about you, but if I am going to make an economic investment in a repair around the house, I want to speak to the person that will be doing the job, sometimes even having them to the house to see whether I like them and find them trustworthy.  Will that skilled and experienced person be the one doing the job, or at least, overseeing the work being done, ensuring nothing goes wrong? If I have a question, will this person with whom I’m building a rapport be available, only a phone call away? 

Why should an investment in your body and overall health be any different?  Talk to your surgeon, get a feel for who they are and what they can offer you.  After all, you are the consumer.  You are the investor, investing in your health, making the educated decision for yourself and your family moving forward. 

This will take time for you to conduct the vetting process, but this is important and shouldn’t be compromised.  After all, more likely than not, your adrenal gland condition has been undiagnosed for years. That adrenal tumor has been growing for at least 3-5 years.  So, what are a few more weeks going to do to your overall health in finding the best, most experienced surgeon for your adrenal gland removal?  Take this necessary time, since this will provide you the opportunity to feel the most comfortable and achieve valuable peace of mind, which is priceless and can equate to future surgery success.

4) Talk to your trusted friends and family to discuss your choice of surgeon for adrenal gland removal

Your friends and family may ask, “Why are you getting on a plane to have your adrenal surgery? Why can’t you do it here?  Are you really going to get on a plane and have surgery and then fly back the next day?” They may question whether you instead need a frontal lobotomy rather than adrenal gland removal. 

However, this is what people do when faced with tricky surgery, or surgery for uncommon diseases. Consider all that you will go through in your home town when being evaluated for adrenal gland removal. Some surgeons will require expensive X-ray testing (MIBG and/or MRI), additional office visits to go over blood work and X-ray results, and then a separate visit for preoperative scheduling.  All of these visits and tests can add-up, affecting your wallet, taking away your valuable time from work and family, and adding to your stress and anxiety.  Wouldn’t it be nice to have a one-stop shop, somewhere that allows your expert surgeon to counsel you directly on what your blood tests mean, enabling you to travel for your surgery with the confidence that you’ve made the best decision for you and your health?  With this direct contact and review by your expert surgeon, costs, time, and stress are minimized.  This should be a no-brainer and an easy explanation to your friends and family.  They will appreciate your due diligence and know that you have thought of everything and made the best choice for you and them.

Traveling for expert care provides another advantage: Peace of Mind.

It is helpful to find a surgeon-driven team and center that recognizes the importance of peace of mind.  Peace of mind comes with knowing you have researched and vetted the best option for you.  Peace of mind is being able to hold the hand of your loved one as you are wheeled off to surgery and as you wake-up from anesthesia.  No matter how far you have traveled for that priceless peace of mind, your outcome and recovery will be optimized.  Peace of mind comes from knowing that you have done your research and you have set yourself up for the best possible outcome.

Additional Resources: 

Learn more about the Carling Adrenal Center

Learn more about Dr. Tobias Carling

Learn more about our sister surgeons at the Norman Parathyroid Center, Clayman Thyroid Center and Scarless Thyroid Surgery Center