Adrenal Surgery (Laparoscopic & Retroperitoneal Adrenalectomy) in Johannesburg

What it involves

Minimally invasive adrenalectomy — through three or four small incisions — is the standard of care for most benign adrenal tumours. Dr Marais offers both routes to the gland: the transperitoneal approach through the abdomen, and the retroperitoneal (posterior retroperitoneoscopic) approach through the flank and back, which reaches the adrenal gland directly without entering the abdominal cavity at all.

Adrenal tumours fall into three broad groups. Functional tumours secrete hormones — cortisol (Cushing's syndrome), aldosterone (Conn's syndrome), or catecholamines (phaeochromocytoma). Non-functional incidentalomas are found on scans done for other reasons. Rarely, adrenal cortical carcinoma or metastasis is the cause.

Phaeochromocytoma requires two to three weeks of alpha-blockade before surgery to prevent dangerous blood-pressure swings intra-operatively. This preparation is done in partnership with an endocrinologist and the anaesthetic team, and is what makes phaeochromocytoma surgery safe in experienced hands.

The laparoscopic approach can be transperitoneal (through the abdomen) or retroperitoneal (through the flank and back). In the transperitoneal route the bowel, and on the right the liver, are gently moved aside to expose the gland — a familiar route with wide views of the surrounding vascular anatomy. In the retroperitoneal route the patient is positioned on the side or face-down, three small ports are placed directly over the flank, and the surgeon works in the narrow space behind the abdominal lining, arriving at the adrenal gland from behind.

The retroperitoneal approach has real advantages in selected patients. Because the abdominal cavity is never opened, the bowel is not handled at all — so wind and bowel function return quickly, pain is usually less, and previous abdominal operations or adhesions become almost irrelevant. It is especially useful for smaller benign tumours, for patients who have had prior abdominal surgery, and when both glands need to be removed at one sitting. Larger tumours, suspected malignancy and unusual anatomy are generally better served by the transperitoneal route, and Dr Marais performs both.

When it's indicated

Functioning adrenal tumours, incidentalomas above 4 cm, tumours showing suspicious features on cross-sectional imaging, or when hormonal testing shows autonomous secretion.

The approach

Adrenal surgery is delicate and low-volume by nature. Preparation matters — particularly for phaeochromocytoma — and the team includes anaesthetists comfortable with these cases. Choosing between the transperitoneal and retroperitoneal route is part of the plan discussed at consultation.

Recovery

Two nights in hospital typically, and often shorter after a retroperitoneal adrenalectomy where the bowel is untouched. Return to desk work at one to two weeks; heavy activity at four weeks. Hormonal cure — resolution of high blood pressure, weight, mood — usually follows within weeks to months.