Adrenal Surgery

What are the adrenal glands?

The adrenal glands are two small, triangular glands that sit on top of each kidney. They produce hormones that help regulate blood pressure, salt and water balance, sex hormones, and the body's response to stress (including cortisol and adrenaline). Because they live directly above the kidneys, adrenal surgery falls within a urologist's operative field.

When is adrenal surgery needed?

• Functioning tumours - adrenal lesions that produce excess hormones, such as:
  • Phaeochromocytoma (excess adrenaline)
  • Conn's adenoma / primary aldosteronism (excess aldosterone - high blood pressure, low potassium)
  • Cushing's adenoma (excess cortisol)
• Suspicious lesions on imaging - particularly if they are large, growing, or have features suggesting a primary adrenal cancer.
• Metastatic disease where the adrenal is the only site of spread from another cancer, in selected cases.

Not every adrenal lesion needs surgery. Small, non-functioning adrenal "incidentalomas" are common and are often safely watched with repeat imaging and hormone tests.

How Dr Kooner performs it

Under general anaesthetic, the patient is positioned on their side. Four small keyhole incisions give access to the space behind the peritoneum. The adrenal gland is carefully freed from surrounding tissues, the adrenal vein is divided with secure clips, and the gland is removed inside a specimen bag.

The kidney below is typically preserved and untouched.

Your journey - what to expect

1. Before

   Endocrine work-up

   Blood tests, urine tests and imaging are arranged, usually in collaboration with an endocrinologist, to confirm what (if anything) the tumour is producing.

2. Preparation

   Medication & planning

   Some tumours (particularly phaeochromocytoma) require blood-pressure preparation with alpha-blockers for 1–2 weeks before surgery.

3. Surgery

   Day of operation

   Typically 1.5–3 hours, under general anaesthetic.

4. 2–3 days

   Hospital stay

   Early mobilisation and eating. Most patients go home within 2–3 days.

5. Follow-up

   Hormone review

   Follow-up blood pressure and hormone checks with the endocrinology team confirm that excess hormone production has resolved.

Risks & considerations

• Bleeding - the adrenal is a highly vascular gland.
• Blood-pressure fluctuations during surgery, particularly for phaeochromocytoma.
• Injury to nearby organs (kidney, spleen, pancreas, liver) - uncommon with experienced laparoscopic and robotic technique.
• Adrenal insufficiency after removal of a cortisol-producing tumour - managed with short-term steroid replacement, which usually tapers over weeks to months.
• Standard anaesthetic, DVT, wound and infection risks.

Frequently asked questions

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