With a multidisciplinary approach and a host of surgical options, endocrine surgeons at Johns Hopkins perform among the highest volumes of adrenal surgeries nationwide.

“As a referral center for evaluation and management of adrenal diseases, our group will complete nearly 100 adrenalectomies this year,” says Lilah Morris-Wiseman, chief of the Division of Endocrine Surgery. High volume is generally considered six or more of the procedures annually, according to the American Association of Endocrine Surgeons Guidelines for Adrenalectomy, which Morris-Wiseman co-authored.

“What sets us apart,” she says, “is that we work as a multidisciplinary team.” She herself is on track to perform about 60 procedures in 2023. “It’s not just about one surgeon or one endocrinologist,” she explains, “but everyone coming together to discuss complex cases. We meet twice a month. We review all the data. We review the imaging and the pathology. It’s really the best of all worlds.”

Morris-Wiseman co-directs the Johns Hopkins Comprehensive Adrenal Center along with endocrinologist Amir Hamrahian, the center’s medical director. The two work in a joint clinic to manage patients. They also host regular tumor board meetings with medical and surgical experts to devise individualized treatment plans. Participating surgeons include Aarti Mathur from the endocrine surgery division, Nirmish Singla from the Brady Urological Institute, and Kelly Lafaro from the hepato-pancreato-biliary surgery program.

Another factor that sets the Johns Hopkins adrenal surgery team apart from others is its repertoire of procedures to allow for personalized care, Morris-Wiseman says. “We recognize that minimally invasive laparoscopic or robotic surgery is great for most patients, but for those who have large adrenal cancers, we perform open surgery to ensure an excellent oncologic outcome,” she says.

Procedures used by the team include:

• Laparoscopic or robotic adrenalectomy: minimally invasive procedure using small incisions to access and remove the diseased adrenal gland
• Posterior retroperitoneoscopic adrenalectomy: minimally invasive surgery performed through tiny incisions in the back rather than through the abdomen
• Open adrenalectomy: surgery performed through a larger incision in the abdomen, which is required to remove the adrenal gland completely and intact to prevent disease from coming back
• Partial (cortical-sparing) adrenalectomy: procedure to remove part of the adrenal gland while sparing the rest
• Bilateral adrenalectomy: surgery to remove both adrenal glands, usually done minimally invasively

Generally, patients stay overnight in the hospital but can then recover at home. The team is moving toward an enhanced recovery after surgery (ERAS) protocol, which ensures that they incorporate the latest evidence-based medicine for pre-, intra- and postoperative care.

“Our goal is to provide the highest-quality multidisciplinary care for our patients,” Morris-Wiseman says.