Adrenal Surgery (Laparoscopic Adrenalectomy) in Johannesburg

What it involves

Laparoscopic adrenalectomy — through three or four small incisions — is the standard of care for most benign adrenal tumours. Dr Marais's endocrine surgical training makes this a familiar operation rather than an unfamiliar one.

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 back). Both give excellent results; Dr Marais uses the transperitoneal approach for most cases with good visualisation of the surrounding vascular anatomy.

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.

Recovery

Two nights in hospital typically. 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.