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Laparoscopic vs open adrenalectomy | CION Cancer Clinics
Most adrenal glands are removed by keyhole (laparoscopic) surgery, with a few small cuts and a camera. Open surgery, through one longer cut, is kept for large tumours, suspected adrenal cancers and tumours growing into nearby organs. Neither is the lesser operation. This page explains what decides the route, how recovery differs, and what to ask your surgeon before you agree. CION Cancer Clinics’ surgical oncologists in Hyderabad can talk this through with you.
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Medically reviewed by Dr. Muralidhar MuddusettyConsultant Surgical Oncologist · MBBS (AIIMS), MS (Surgery, AIIMS), DNB (Surgical Oncology), MRCS (Edinburgh) · last reviewed September 2026, next review due September 2027
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On this page
- Keyhole or open: which one will I have?
- Keyhole and open adrenalectomy, compared
- When does the surgeon choose an open cut?
- How does recovery differ between the two?
- Four things families ask us, and what is actually true
- What to ask before you agree to either route
- What this page cannot tell you
- Common questions about keyhole and open adrenal surgery
The short answer
Keyhole or open: which one will I have?
Most adrenal glands today are removed by keyhole (laparoscopic) surgery, because the gland is small and sits deep, which is exactly what a camera and long instruments are good at. Open surgery is kept for large tumours, tumours that look like an adrenal cancer on the scan, and tumours growing into the tissue around them.
They are not two grades of the same operation
Keyhole surgery is not the "lesser" operation and open surgery is not the "serious" one. Both remove the whole gland with the tumour unopened inside it. The difference is the route in: several small cuts and a camera, or one longer cut and the surgeon's hands.
What the choice is actually based on
Three things above all: the size of the tumour, whether the scan suggests a cancer, and whether it appears to be growing into the kidney, liver, blood vessels or the fat around it. Your surgeon's experience matters too. A surgeon who does adrenal surgery regularly can remove larger tumours by keyhole, and will also know when not to try.
Robot-assisted keyhole surgery is a form of laparoscopic surgery, not a third option. Ask your centre what they offer and why.Side by side
Keyhole and open adrenalectomy, compared
Keyhole (laparoscopic)
Open
Three or four small cuts and a camera
One longer cut under the ribs or down the middle
Usually home within a couple of days
Usually closer to a week in hospital
Less pain, quicker return to eating and walking
More pain relief needed, slower first week
Preferred for small and medium tumours that look benign
Preferred for large tumours and suspected adrenal cancer
Can be converted to open mid-operation if needed
Gives the surgeon direct hands-on control from the start
The exceptions
When does the surgeon choose an open cut?
If one of these applies to you, an open operation is a considered choice, not a step backwards.
A large tumour
Big tumours are hard to handle with long instruments, and they must come out through a cut of their own size anyway. The larger the lump, the more likely an open route is safer.
A suspected adrenal cancer
If the scan shows an irregular, dense or fast-growing mass, the surgeon wants to remove it with a rim of healthy tissue and without any risk of breaking the capsule. Open surgery makes that easier.
The scan signs that raise concern
- Irregular edges or patchy centre
- Growth between two scans
Growth into nearby organs
When the tumour has grown into the kidney, the liver, or the large vein beside the gland, part of those may need to be removed too. That is open surgery, and sometimes a wider team.
Conversion during keyhole surgery
Occasionally a keyhole operation starts and the surgeon finds scarring, bleeding or a tumour stuck to its neighbours. Switching to an open cut at that point is the safe decision.
You will have consented to this possibility beforehand. It is a judgement, not a mistake.Not sure whether this applies to you?
Ask an oncologistRecovery, compared
How does recovery differ between the two?
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The first day
After keyhole surgery, sips of water the same evening and a walk with help the next morning. After open surgery, the same goals, but a day or two later and with stronger pain relief, often through an epidural or a pump you control.
-
Going home
Keyhole patients usually leave within a couple of days once eating, walking and passing urine normally. Open patients stay until the wound is settled and pain is controlled on tablets, usually closer to a week.
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The first weeks at home
Small keyhole wounds heal quickly, and shoulder-tip pain from the gas fades within days. An open wound needs the muscle to knit, so bending, lifting and driving wait longer.
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Back to normal life
Desk work and light activity return sooner after keyhole surgery. After open surgery, heavy work and lifting are held back for longer to protect the wound from a hernia. Your surgeon gives you a timescale for your own job.
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What is the same for both
The hormone changes after the gland is removed, the pathology report, the follow-up visits and any steroid tablets are identical whichever route was used. The route changes the recovery, not the aftercare.
Commonly believed
Four things families ask us, and what is actually true
"Keyhole surgery might leave some of the tumour behind."
Both routes remove the whole gland with the tumour sealed inside it. Keyhole surgery is chosen only where the surgeon is confident of doing that completely. Where they are not, they choose open. The pathology report checks the margins either way.
"Open surgery means the cancer has spread."
Open surgery is chosen for size, scan appearance or nearby growth, and sometimes simply for a surgeon's judgement about safety. Many people who have open surgery turn out to have a benign tumour that was just large.
"We should insist on keyhole because the scar is smaller."
The scar is the least important thing about this operation. A keyhole attempt on a tumour that needed an open cut risks breaking the capsule or heavy bleeding. Ask why the surgeon has chosen their route, and listen to the reason.
"Robotic surgery is the newest, so it must be the safest."
Robot-assisted surgery is keyhole surgery with a different set of instruments. Whether it helps depends on the tumour and the surgeon's experience with it, not on the machine. Ask any centre offering it what it would change in your case.
Take this to the appointment
What to ask before you agree to either route
- Which route are you planning for me, and what about my tumour decided it?
- How many adrenal operations does your team do in a year?
- What would make you convert from keyhole to open during the operation?
- Will I go to a high-dependency bed afterwards, and for how long?
- How long will I be in hospital, and when could I return to my work?
- Will I need steroid tablets afterwards, even for a short while?
Being straight with you
What this page cannot tell you
This page cannot tell you which route is right for your tumour. That decision needs your scans, your hormone results and a surgeon looking at them together. What it can do is help you understand the reason you are given, and notice if no reason is given at all.
Who keyhole surgery does not suit
Very large tumours, tumours that look like a cancer growing into neighbouring organs, and some people with heavy scarring from earlier abdominal operations. People whose heart or lungs would not tolerate the gas used to inflate the abdomen may also be steered towards a different route, including keyhole surgery from the back, which uses less pressure.
Who open surgery does not suit
Most people with a small or medium benign tumour, for whom it would mean a longer stay and a slower recovery for no gain. Someone frail or elderly usually does better with the smaller wounds of keyhole surgery, provided the tumour allows it.
If you are told open surgery is the only option and the reason is unclear, a second opinion from a surgeon who does adrenal surgery regularly is reasonable and common.Questions we are asked
Common questions about keyhole and open adrenal surgery
Is keyhole surgery safe for a phaeochromocytoma?
Yes, and it is the usual route for one that is not very large. The hormone surge during handling is managed by the anaesthetist whichever route is used, so the preparation with blocking tablets and the arterial line are the same. Very large or suspicious adrenaline-producing tumours may still need an open cut.
How big is too big for keyhole surgery?
There is no fixed cut-off, and experienced adrenal surgeons remove larger tumours by keyhole than they did a decade ago. What matters more than the measurement is whether the tumour looks like a cancer and whether it is free of its neighbours. Ask your surgeon where they draw the line and why.
What is the difference between keyhole through the belly and through the back?
Both are keyhole. Through the belly, the surgeon enters the abdominal cavity and moves organs aside to reach the gland. Through the back, you lie face down and the surgeon reaches the gland directly behind the abdominal lining. The back route suits smaller tumours and people with previous abdominal surgery.
If they convert to open during surgery, has something gone wrong?
Usually not. Conversion happens when the surgeon finds scarring, bleeding, or a tumour stuck to its neighbours, and decides the open route is safer. It is discussed with you beforehand as a possibility. Your recovery then follows the open timeline, but the operation itself has still been completed.
Does keyhole surgery cost more or less?
The theatre charges can be higher for keyhole surgery because of the equipment, but the shorter hospital stay often brings the total closer together. Aarogyasri, CGHS, ECHS, EHS and cashless insurance cover adrenal surgery in many cases. Ask for a written estimate for the route planned, and call the helpline to check your scheme.
Will the scar from open surgery cause problems later?
The main long-term risk of any larger abdominal cut is a hernia, a weakness in the muscle where the wound was. Keeping to the lifting limits you are given while the wound heals is the main protection. Numbness around the scar is common and often improves over months.
Can I ask for a specific route?
You can ask, and you should ask why the surgeon has chosen theirs. But the route is a safety decision based on your tumour, and a surgeon who agrees to keyhole against their own judgement is not doing you a favour. If the reasoning does not satisfy you, a second opinion is the better step.
Is the pathology result different depending on the route?
No. The whole gland goes to the laboratory either way, and the report describes the tumour type, whether it was benign or a cancer, and whether the capsule and margins were intact. The route into the body changes the wounds and the recovery, not what the pathologist finds.
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Dr. C. Raghavendra Reddy
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Dr. Owais Mohammed
MBBS, MD (General Medicine), DrNB (Medical Oncology), ECMO, MRCP SCE (Medical Oncology) (UK)
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Dr. Muralidhar Muddusetty
MBBS (AIIMS), MS (Surgery) (AIIMS), DNB (Surgical Oncology), MRCS (Edinburgh)
Surgical Oncologist
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Dr. Vinay Mamidala
MBBS, MS(General Surgery), M.Ch(Surgical Oncology), FMAS, FARIS(Ongoing)
Surgical Oncologist
Radiation Oncologist
Radiation Oncologist
Radiation Oncologist
Hematologist
Surgical Oncologist
Dr. Vajja Sandeep Kumar
MBBS, MS (General Surgery), DrNB (Surgical Oncology), FALS Oncology
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Sources
- Cancer Research UK — Surgery for adrenal gland cancer
- National Cancer Institute — Adrenocortical Carcinoma Treatment (PDQ) - Patient Version
- Cancer.Net (ASCO) — Adrenal Gland Tumor: Types of Treatment
- NHS — Phaeochromocytoma
This page is general information, not a prescription. Do not change or stop any treatment based on what you read here. If anything is worrying you, contact your own treating team — or call our helpline and we will help you reach the right specialist.
Keep reading
Related pages
Posterior Retroperitoneoscopic ApproachThe keyhole route from the back, explainedAdrenalectomy: What the Operation InvolvesThe operation from admission to going homeAdrenalectomy Cost in HyderabadIndicative ranges for each route and what schemes coverChoosing a Surgeon and a CentreHow to judge experience before you agreeWound, Stitches and ScarsLooking after keyhole and open wounds at home
Talk to us
Been offered one route and want to understand why?
Send us your scan and hormone reports or call the helpline. A surgical oncologist will explain what your tumour's size and appearance mean for the choice. One helpline serves every CION centre.