5 techniques to make endocrine surgery safer
September 22, 2016
Your endocrine system – the pancreas and the thyroid, parathyroid, and adrenal glands – is a complex system. These organs produce and regulate many of the hormones that help your body function day to day.
When something is out of whack in your endocrine system, it can make you feel terrible. In severe cases, such as when a tumor develops or the organ stops working, you could suffer severe illness or even death.
Endocrine surgery is complex, too. The organs are well-protected within the body, tucked behind other vital organs and surrounded by delicate blood vessels. They’re hard to reach, and this, paired with changes to hormone functions, makes recovery difficult.
My team’s goals are to treat patients with endocrine conditions effectively and safely and to decrease recovery times. Let’s discuss five techniques we use to accomplish these goals.
1. Robotic surgery: pancreatic surgery and adrenal disease
Most patients with tumors in the distal portion (the tail) of the pancreas could benefit from robotic surgery, which helps us decrease the risk for complications that can arise during traditional pancreas surgery.
The pancreas sits behind the stomach in the back of the abdomen, and the adrenal glands are tucked away above the kidneys closer to your back. To operate, your surgeon has to get around corners and through the maze of blood vessels that surround the organs. Traditional laparoscopic surgery may not accomplish this very well. But robotic surgery technology has superior optics to help us see the tumors and tissues even better. Their robotic “arms” have a dynamic range of motion. Our machine’s “wrist” can rotate many more degrees than the human wrist, allowing me to reach the pancreas and adrenal glands. It’s easier on the surgeon and can be safer for the patient to operate robotically.
This is especially true for large adrenal tumors called pheochromocytomas, which carry many small blood vessels that bleed easily. The tumors secrete adrenaline during surgery, which can cause a sudden spike in a patient’s blood pressure. This can be a scary situation and can lead to heart attack or stroke on the operating table.
Robotic surgery helps us carefully navigate around the tumors and their blood vessels to reduce bleeding and allows us to push and move the tumor less, reducing the risk of a sudden cardiovascular event such as a heart attack or stroke.
Another advantage to robotic surgery is that it reduces the size of incisions we have to make to reach the organs, which means less pain after surgery and, often, faster recovery.
2. Preoperative ultrasonography: parathyroid surgery
Primary hyperparathyroidism is a common condition in which one of the four parathyroid glands in the neck secretes excessive hormones. This can cause low bone density and osteoporosis. Treatment often requires removal of only the abnormal gland. If the abnormal gland is removed, the others can typically stay in place without causing problems. The trouble is, the glands are situated in four different parts of the neck, and without ultrasonography it’s often difficult to tell which gland is abnormal before surgery.
In the old days, we’d have to make a large incision and find and visualize each gland. Today, our radiologists use ultrasonography to find the abnormal gland before surgery, which allows us to make one small, directed incision and perform the surgery as an outpatient procedure 80 percent to 90 percent of the time. The benefits to preoperative ultrasonography are clear: smaller incisions leads to less pain and faster recovery for our patients.
3. Intraoperative hormone blood test: hyperparathyroidism
Another facet to primary hyperparathyroidism gland surgery is to ensure the other glands in the neck aren’t secreting extra hormones. We use a relatively new hormone blood test during surgery to be certain.
Once a patient is put under anesthesia for surgery, we place a catheter in the foot and draw a blood sample to get a baseline hormone level. During surgery, we draw three more samples at five, 10, and 20 minutes after taking out the abnormal parathyroid gland. If the 10-minute hormone level is less than half of the baseline level, we consider the surgery curative, and no additional glands are removed. This technology reduces the need for multiple surgeries.
4. Intraoperative nerve monitoring: thyroid surgery
Hoarseness is an irritating complication of thyroidectomy and parathyroid surgery that can be important for patients who depend on their voice for work. The nerves supplying a patient’s vocal cords – and controlling the voice – are located near the thyroid and parathyroid glands. The laryngeal nerve, which affects the ability to use your voice, may be damaged during surgery if certain precautions are not taken.
We use a nerve monitor during neck surgery to assess laryngeal nerve function and reduce the risk of voice changes and hoarseness after surgery. Equally importantly, with this monitor we can reduce the risk of vocal cords being paralyzed or damaged. Though you may still experience a raspy voice or hoarseness after thyroid or parathyroid surgery, these techniques improve the chances that your voice will heal and go back to normal after a few weeks.
5. Tumor boards: endocrine cancer
As mentioned, endocrine conditions (particularly cancer) can be difficult to treat. Our team holds internal monthly meetings to discuss complicated cases and any unusual symptoms that our patients struggle with, as well as new treatment options.
We hold these meetings because we never want to be too comfortable or too sure of our go-to treatment options. It’s important that we get input from radiologists, pathologists, endocrinologists, and other surgeons so we can exhaust all the possibilities for treatment and make sure we give every patient who comes through our door the best chance for a positive outcome. It’s also a chance for all of us to learn from each other.
Our group takes treating complex endocrine conditions personally. We see a lot of patients, and most have complex conditions. We continually research safer, more effective treatment options for people who have endocrine disorders and tumors. Surgery can be difficult, but our goal is simple: to improve patient outcomes through advanced techniques.
If you have questions about endocrine surgery or pancreatic, adrenal, or thyroid surgery recovery, request an appointment or call 214-645-8300.