Endocrine Surgery
What is Endocrine Surgery
Subspecialty discipline within General Surgery, focussed on treatment of the Endocrine System, including the thyroid gland, parathyroid glands, adrenal glands and pancreas.
What is the thyroid gland?
The thyroid gland is an important hormonal gland that sits in front of the trachea in the lower neck. Although it is very small, it is the key regulator of the body’s metabolism. It is therefore vital to the function of your entire body.
What problems of the thyroid gland require surgery?
- Hyperactive thyroid (Graves’ disease, toxic nodule or toxic goitre)
- Symptomatic goitre (e.g. large multinodular goitre) causing compressive or cosmetic concerns
- Thyroid cancer
What problems of the thyroid gland require surgery?
- Hyperactive thyroid (Graves’ disease, toxic nodule or toxic goitre)
- Symptomatic goitre (e.g. large multinodular goitre) causing compressive or cosmetic concerns
- Thyroid cancer
What is thyroid surgery?
- Thyroidectomy is a simple procedure under a general anaesthetic, where a small incision is made, the thyroid gland is mobilised and removed, and key surrounding structures are protected.
- It can be performed as either a total thyroidectomy, where the entire gland is removed, or as a hemithyroidectomy in selected cases, where half of the gland is removed, leaving the remainder to function as normal.
- In the case of total thyroidectomy, patients will be commenced on thyroid hormone replacement from the next day following surgery.
- Thyroidectomy is often performed as a simple overnight stay procedure. It is a largely painless procedure, and recovery is rapid, with return to normal activities within a few days of surgery.
Parathyroid
What are the parathyroid glands?
The parathyroid glands are tiny endocrine glands around the size of a grain of rice, that lay around and behind the thyroid gland. There are usually two on either side. The parathyroid glands function to control calcium metabolism.
What problems of the parathyroid glands require surgery?
- Over activity of the parathyroid glands, aka hyperparathyroidism, can result in increased release of parathyroid hormone, which acts to increase the circulating blood calcium levels. It does this by removing calcium from bones. As a result, the bone mineral density is impaired resulting in osteoporosis and potentially fractures. Additionally, elevated calcium can cause kidney and bladder stones, and psychomotor changes.
- Hyperparathyroidism can be caused by a tumour called an adenoma (the most common cause of primary hyperparathyroidism), or by diffuse overgrowth of the cells of the glands (parathyroid hyperplasia). Certain conditions such as renal failure can also induce cellular overgrowth of the parathyroid glands.
What is parathyroid surgery?
- Parathyroidectomy is a simple procedure under general anaesthetic, where a small incision is made and the relevant parathyroid gland(s) are removed, whilst protecting key surrounding structures.
- Prior to surgery, imaging studies are performed to attempt to localise the abnormal parathyroid gland tumour. When the relevant parathyroid tumour can be localised, the procedure is often called ‘minimally-invasive parathyroidectomy’, which allows for a targeted incision directly overlying the respective gland.
- Parathyroidectomy is often performed as a day procedure, as it is largely painless and recovery is rapid. Patient’s can often return to normal activities within a few days of surgery.
Adrenal / Paraganglionoma
The adrenal glands are unique endocrine glands that sit on top of your kidneys, and are also known as suprarenal glands. They are responsible for the production and regulation of hormones that regulate the body’s stress response and blood pressure, such as adrenaline, noradrenaline, cortisol, aldosterone and dehydroepiandrosterone.
What problems of the adrenal glands require surgery?
- Adrenalectomy may be required for adrenal tumours or specific hormonal problems related to the adrenal glands.
- Adrenal tumours can be either non-functional (where they are commonly found incidentally during a scan for another reason) or functional (where the tumour abnormally secretes a particular hormone)
- Examples include Phaeochromocytoma, Cushing’s syndrome, Addison’s disease, Conn’s syndrome, congenital adrenal hyperplasia, macronodular adrenal hyperplasia.
What is adrenal surgery?
- Adrenalectomy is commonly performed as a minimally invasive keyhole procedure. This can be performed through the abdomen, as a laparoscopic adrenalectomy, or through the back, as a retroperitoneoscopic adrenalectomy.
- In the setting of a phaeochromocytoma there is specific preoperative optimisation required and perioperative considerations, due to the specific functionality of the adrenal gland. However, in most settings of adrenalectomy (particularly when not for phaeochromocytoma) the procedure is actually a simple overnight admission with very minimal discomfort and early return to normal activities.
Diaphragmatic Hernia
What is a diaphragmatic hernia?
Diaphragmatic hernias are rare,
These are often found incidentally, during scans for other issues. When explored further, most patients have upper abdominal symptoms or impaired heart and lung function, and this has often been a long-standing issue.
They are often present since birth, or after a sudden high-mechanism physical trauma such as a car accident.
What is diaphragmatic hernia surgery?
Diaphragmatic hernia surgery is performed laparoscopically, whereby a camera is inserted into your abdomen along with instrument ports, and sometimes thoracoscopically, where a camera is also inserted into your chest between your ribs. The herniated contents are reduced back into the abdomen and the defect in the diaphragm is defined. The defect is then repaired using a combination of sutures and mesh.
Recovery following a laparoscopic diaphragmatic hernia repair requires you to stay in hospital for a few days to ensure that you have completely recovered prior to discharge home. You will be on a normal diet following surgery. Following discharge home, you will be able to return to work and driving, but will be on restricted activities to minimise any heavy lifting for 6 weeks from surgery.
Achalasia
Achalasia is a unique motility disorder of the oesophagus, where there is failure of the lower-oesophageal sphincter to relax. This results in difficulty swallowing, and patients have often struggled for a long time prior to seeking medical attention. Patients have often restricted their own diet to soft, puree foods or even liquids and suffer nutritional failure.
How is achalasia treated?
- There are several treatment options available depending on your other medical issues and nutritional status. The goal is to restore nutrition and improve the swallowing mechanism.
- Endoscopic options include balloon dilatation and per-oral endoscopic myotomy (POEM). Balloon dilatation is a highly effective treatment option, but with some specific pros and cons, which will be discussed with you at time of consultation. POEM is a procedure that is not offered by our group, but we liaise closely with the specialists in Brisbane who do perform this procedure and if we feel that this is the best option for you, we will refer you onwards accordingly.
- Surgical options include a laparoscopic Heller’s myotomy, which is the most effective and durable treatment option. The procedure is minimally invasive, where a camera is inserted into the abdomen along with instrument ports. The oesophagus and stomach are carefully dissected, and the muscles are carefully divided to release their extrinsic compression of the oesophagus.
- Recovery is excellent following a laparoscopic Heller’s myotomy, and patient’s often feel dramatically improved immediately following surgery.
Cancers of the Foregut
Thankfully, cancers of the foregut (oesophagus, stomach, pancreas, liver) are rare in the population. However, when they occur they can present silently or with symptoms that can be quite distressing.
- If found early, these cancers may present with weight loss, loss of appetite, difficulty swallowing, abdominal discomfort and jaundice.
- Patients will undergo a clinical assessment involving a detailed history and physical examination, and then undergo a series of tests including blood and imaging. A CT scan will usually yield some clues as to where the problem may be.
- Patients will often then undergo an endoscopic evaluation for direct visualisation and biopsy.
- Your surgeon will then arrange ‘staging’ investigations to be completed, which may include a PET scan.
- Your surgeon will then review your case in a multidisciplinary team meeting, where the appropriate treatment plan can be formulated and presented to you.