Minimally Invasive Endocrine Surgery
A) Minimally Invasive Thyroid Surgery
Minimally invasive thyroid surgery is the removal of one half or whole thyroid gland through a small mid neck incision. It is performed either under general anesthesia or local-regional block. Local-regional block is performed with neck block (regional anesthesia) and light general sedation (like it is done with colonoscopy procedures). It can be done under general anesthesia with nerve monitoring (recurrent laryngeal nerve and external branch of the superior laryngeal nerve). With minimally invasive surgery the incision is placed in the natural skin crease. Minimally invasive surgery also includes video-assisted or endoscopic thyroidectomy, when surgeon uses camera to magnify the view. This technique makes the healing process faster and with minimum scar formation. Surgeon does not use any drains or tubes that are inserted during the surgery and left for a day after the surgery. Skin is closed either with subcuticular sutures (under the skin, dissolvable) or without any sutures by using a skin glue. minimally invasive surgery is usually the same day surgery. Patient stay in the hospital after the surgery for 6 hours observation only.
B) Minimally Invasive Parathyroid Surgery
Minimally invasive parathyroid surgery is the removal of one or several parathyroid glands (adenomas) through a small transverse mid neck incision. The incision is placed in the natural skin crease. Minimally invasive parathyroid surgery includes video-assisted or endoscopic parathyroidectomy, when surgeon uses camera to magnify the view. This technique makes the healing process faster and with minimum scar formation. In order to perform minimally invasive approach preoperative studies to localize adenoma must be used. Those studies include preoperative neck ultrasound and Sestamibi (parathyroid) scan. I am also utilizing intra-operative parathyroid hormone (PTH) monitoring to determine the cure after the removal of parathyroid adenoma immediatly during surgery. Majority of the patients have this procedure performed under local anesthesia with neck block (regional anesthesia) with general sedation (like it is done with colonoscopy procedures). About 85 % of the patients with primary hyperparathyroidism will have just one parathyroid adenoma. Surgeon does not use any drains. Skin is closed either with subcuticular sutures (under the skin, dissolvable) or without any sutures by using a skin glue. It is usually the same day surgery. Patient stays in the hospital after the surgery for 3 hours of observation.
Intra-operative PTH monitoring
C) Minimally Invasive Adrenal Surgery
Minimally invasive adrenal surgery is laparoscopic removal of the adrenal tumor only (partial adrenalectomy) or entire gland with the tumor through the abdominal or back approaches: laparoscoipc transabdominal lateral adrenalectomy (through the abdomen) or more advanced and modern approach as posterior retroperitoneoscopic adrenalectomy - laparoscopic posterior retroperitoneal adrenalectomy through the back. The best for the patient and more advanced approach is from the back - posterior retroperitoneoscopic adrenalectomy. Posterior retroperitoneoscopic adrenalectomy (PRA) is truly minimally invasive adrenal surgery, patients have minimal pain and able to go back to normal activities the day of the surgery. has the best cosmetic result, but it is only performed by limited number of endocrine surgeons in the country, such as it requires high level of expertise and advanced training (see it on YouTube: http://youtu.be/g1z3hjlUosw). There will be 3 small incisions instead of one large incision used with open approach. Minimally invasive laparoscopic technique makes the healing process faster and with minimum scar formation. Most of the time, patient is staying in the hospital over night and will be discharged to home the next day. For more information and pictures please see my other web pages www.adrenaltumors.org