HomeMinimally Invasive Endocrine Surgery
A) Minimally Invasive Thyroid Surgery
Minimally invasive thyroid surgery is the removal of one half or the whole thyroid gland through a small mid-neck incision. It is performed either under general anesthesia or, very rarely, under local-regional block. Under general anesthesia, the procedure is performed with monitoring of the recurrent laryngeal nerve and the 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 the surgeon uses a camera to magnify the view. This technique speeds up the healing process and reduces scar formation. A surgeon does not use any drains or tubes inserted during surgery that are left in place 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 performed on a same-day basis. The patient stays in the hospital for 6 hours of observation only after surgery.
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 open parathyroidectomy through a small incision, video-assisted or endoscopic parathyroidectomy, when the surgeon uses a camera to magnify the view. This technique speeds up the healing process and reduces scar formation. To achieve a minimally invasive approach, preoperative studies to localize the adenoma must be performed. 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 immediately during surgery. The majority of the patients have this procedure performed under local anesthesia with neck block (regional anesthesia) with general sedation (as is done with colonoscopy procedures). About 85 % of the patients with primary hyperparathyroidism will have just one parathyroid adenoma. The 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. The patient stays in the hospital for 3 hours of observation after surgery.
Intra-operative PTH monitoring
Click on image to view video "Minimally Invasive Video-Assisted Parathyroidectomy"
C) Minimally Invasive Adrenal Surgery
Minimally invasive adrenal surgery is the laparoscopic removal of the adrenal tumor only (partial adrenalectomy) or entire gland with the tumor through the abdominal or back approaches: laparoscopic transabdominal lateral adrenalectomy (through the abdomen) or a more advanced and modern approach, such as posterior retroperitoneoscopic adrenalectomy - laparoscopic posterior retroperitoneal adrenalectomy through the back. The best for the patient and the most advanced approach is from the back - posterior retroperitoneoscopic adrenalectomy. Posterior retroperitoneoscopic adrenalectomy (PRA) is truly minimally invasive adrenal surgery; patients have minimal pain and can go back to normal activities the day of the surgery. Has the best cosmetic results, but is performed by only a limited number of endocrine surgeons in the country, as it requires a high level of expertise and advanced training (see it on YouTube: http://youtu.be/g1z3hjlUosw). There will be three small incisions instead of one large incision used with the open approach. Minimally invasive laparoscopic technique makes the healing process faster and with minimal scar formation. Most of the time, the patient stays in the hospital overnight and is discharged home the next day. For more information and pictures, please see my other web pages www.adrenaltumors.org
