Endocrine surgery is a surgical sub-speciality focusing on surgery of the

endocrine gland Endocrine glands are ductless glands of the endocrine system that secrete their products, hormones, directly into the blood. The major glands of the endocrine system include the pineal gland, pituitary gland, pancreas, ovaries, testes, thy ...

s, including the thyroid gland, the parathyroid glands, the adrenal glands, glands of the endocrine pancreas, and some neuroendocrine glands.

Types

Thyroid surgery

Surgery of the

thyroid gland The thyroid, or thyroid gland, is an endocrine gland in vertebrates. In humans it is in the neck and consists of two connected lobes. The lower two thirds of the lobes are connected by a thin band of tissue called the thyroid isthmus. The thy ...

constitutes the bulk of endocrine surgical procedures worldwide. This may be done for a variety of conditions, help ranging from benign

multinodular goiter A goitre, or goiter, is a swelling in the neck resulting from an enlarged thyroid gland. A goitre can be associated with a thyroid that is not functioning properly. Worldwide, over 90% of goitre cases are caused by iodine deficiency. The term is ...

thyroid cancer Thyroid cancer is cancer that develops from the tissues of the thyroid gland. It is a disease in which cells grow abnormally and have the potential to spread to other parts of the body. Symptoms can include swelling or a lump in the neck. Ca ...

. In the United Kingdom it was developed as a separate specialty from general surgery by Richard Welbourne and John Lynn, surgeons at what was then the 'Royal Postgraduate Medical School' and is now the

Hammersmith Hospital Hammersmith Hospital, formerly the Military Orthopaedic Hospital, and later the Special Surgical Hospital, is a major teaching hospital in White City, West London. It is part of Imperial College Healthcare NHS Trust in the London Borough ...

and contains the Department of Thyroid and Endocrine Surgery staffed by consultant surgeons Professor Fausto Palazzo, Professor Neil Tolley and Miss Aimee Di Marco. Operations involve removal of the thyroid gland (

thyroidectomy A thyroidectomy is an operation that involves the surgical removal of all or part of the thyroid gland. In general surgery, endocrine or head and neck surgeons often perform a thyroidectomy when a patient has thyroid cancer or some other conditio ...

) either as a part of the gland (lobectomy or hemithyroidectomy), or the whole gland (total thyroidectomy). Incomplete resections (sub-total or near total thyroidectomy) are also infrequently performed, but are disfavored by most surgeons.

Parathyroid surgery

Removal of the parathyroid gland(s) is referred to as

parathyroidectomy Parathyroidectomy is the surgical removal of one or more of the (usually) four parathyroid glands. This procedure is used to remove an adenoma or hyperplasia of these glands when they are producing excessive parathyroid hormone (PTH): hyperpara ...

and is most commonly performed for

primary hyperparathyroidism Primary hyperparathyroidism (or PHPT) is a medical condition where the parathyroid gland (or a benign tumor within it) produce excess amounts of parathyroid hormone (PTH). The symptoms of the condition relate to the resulting elevated serum calcium ...

. Parathyroidectomy is also performed to treat tertiary hyperparathyroidism arising from chronic

kidney failure Kidney failure, also known as end-stage kidney disease, is a medical condition in which the kidneys can no longer adequately filter waste products from the blood, functioning at less than 15% of normal levels. Kidney failure is classified as eit ...

Adrenal surgery

adrenalectomy Adrenalectomy (Latin root Ad "near/at" + renal "related to the kidneys" + Greek '' ‑ectomy'' “out-cutting”; sometimes written as ADX for the procedure or resulting state) is the surgical removal of one ( unilateral) or both (bilateral) adr ...

, i.e. surgical removal of the adrenal gland is done in conditions like

Conn syndrome Primary aldosteronism (PA)'','' also known as primary hyperaldosteronism or Conn's syndrome, refers to the excess production of the hormone aldosterone from the adrenal glands, resulting in low renin levels and high blood pressure. This abnormali ...

pheochromocytoma Pheochromocytoma (PHEO or PCC) is a rare tumor of the adrenal medulla composed of chromaffin cells, also known as pheochromocytes. When a tumor composed of the same cells as a pheochromocytoma develops outside the adrenal gland, it is referred t ...

, adreno-cortical cancer etc.

Pancreatic surgery

Diseases of the endocrine pancreas occur very infrequently; these include

insulinoma An insulinoma is a tumour of the pancreas that is derived from beta cells and secretes insulin. It is a rare form of a neuroendocrine tumour. Most insulinomas are benign in that they grow exclusively at their origin within the pancreas, but a mi ...

gastrinoma Gastrinomas are neuroendocrine tumors (NETs), usually located in the duodenum or pancreas, that secrete gastrin and cause a clinical syndrome known as Zollinger–Ellison syndrome (ZES). A large number of gastrinomas develop in the pancreas or duod ...

s etc. Surgery for these conditions range from simple tumor enucleation to more larger resections.

Development

Endocrine surgery is generally well developed. Endocrine surgery has developed as a sub-specialty surgical category because of the technical nature of these operations and the associated risks of operating in the neck. In ''Surgery: Basic Science and Clinical Evidence'', the book the efficacy prior research: In the 1970s, a specialty training program at

was the primary location for early work in training a large number of surgeons. It is well established that complications are much less common if performed by surgeons who do at least 100 thyroid operations per year. In the United Kingdom most thyroid surgery is performed by surgeons doing less than 20 thyroid operations per year. Permanent damage to both voice box nerves is an extreme rarity and needs in most cases a permanent tracheostomy. Data on the outcomes of all surgeons performing endocrine surgery in the UK is publicly available via the
British Association of Endocrine and Thyroid Surgeons
website.

Technique

Thyroid surgery

Some surgical teams leave wound drains in place after surgery to the thyroid gland. There is no strong evidence that wound drains improve outcomes following surgery and there is low-quality evidence that wound drains increase the length of time a person stays in the hospital following thyroid surgery.

References

{{Endocrine system procedures