Traditionally adrenal surgery has been performed via a keyhole approach through the front of your abdomen. Dr Green is now routinely performing what is referred to as a ‘Retroperitoneal laparoscopic approach’ this is still a keyhole approach that removes the adrenal through your back.
There are a number of benefits to this type of adrenal surgery. The most beneficial improvement is a faster recovery time. Patients are usually up and about the same evening after the surgery and nearly all are ready to go home the next day. This results in a faster return to normal activities and less time away from work.
In the previous older approach from the front of your abdomen not all patients where suitable for a keyhole operation. If you have had previous abdominal surgery the keyhole approach is often not suitable or possible and a large cut was needed. This results in a prolonged hospital stay and lengthy painful recovery. The approach through the back that is performed by Dr Green can still be performed even if you have had previous abdominal surgery. Therefore, people who may not be offered keyhole surgery if having a front approach will now be suitable for a keyhole approach.
Secondly, many people are now overweight and carrying a few extra kilos than is ideal. The increased fat often made the anterior keyhole approach difficult and challenging. With the back approach abdominal fat does not get in the way and does not make the operation significantly more difficult. The posterior approach will result in less patients needing conversion to an open procedure due to their body fat and thus avoiding a large cut to complete their surgery.
Thirdly, via the back approach the instruments used to remove the adrenal gland do not have to pass in and out next to bowel. Therefore, there is a significantly reduced potential for injury to the abdominal organs making the back approach a potentially safer operation.
The back approach has been routinely performed in many large centres in the USA with excellent results confirming a faster recovery, lower conversion to open surgery with large incisions and low complication rates.