There are currently two different types of minimally invasive (laparoscopic or ‘keyhole’) operations to remove adrenal glands performed worldwide.
These two types of operation are:
In both operations surgical removal of the adrenal gland is performed by instruments inserted into the body using 3-4 small incisions (cuts), resulting in eventual scars around 1-2cm in size. In the retroperitoneoscopic operation the scars are on the back, whereas in the laparoscopic operation the scars are on the flank.
Whereas the laparoscopic operation is performed by many adrenal surgeons, the retroperitoneoscopic operation is performed by only a small number of surgeons in the UK. Mr Hardy is one of the few surgeons in the UK who performs both types of operation.
Because the adrenal glands are next to the kidney in the ‘back’ of the abdomen (or to give it the technical name, ‘retroperitoneum’), this type of operation is the most direct approach to the adrenal gland. 3 small incisions on the back are used in the operation.
This operation gives the least post-operative pain and quickest recovery to normal activities of any type of adrenal surgery, even compared to laparoscopic adrenalectomy. Many people are discharged home the day following surgery after undergoing this operation. This type of operation is also very good for people who have had previous surgery on their abdomen (belly) for whom a laparoscopic approach is usually very difficult because of internal scarring.
Mr Hardy is one of only a very small number of surgeons in the UK performing this operation.
In this operation the adrenal gland is removed through 3-4 small cuts on the flank. Recovery from this operation is still usually rapid, but there is often greater postoperative discomfort for a day or two compared to retroperitoneoscopic adrenalectomy. This is because the gas that has to be inserted into the abdominal (or peritoneal) cavity in order to perform this operation usually gives more postoperative pain than the wounds themselves.
Mr Hardy performs this operation for adrenal masses that are too large to be removed by a retroperitoneoscopic approach. This usually means masses larger than 5cm.
The picture below shows typical scars following this procedure. This picture was taken 6 weeks following surgery. The scars will fade over time to become barely visible.
Adrenal masses up to around 5cm in size are suitable for removal by this type of operation. Masses larger than this are usually removed by laparosopic adrenalectomy, which is covered in the following section.
Adrenal masses larger than 10cm, or those that are malignant (cancerous) should be removed using an ‘open’ approach by a larger scar across the abdomen.