Endocrine Surgery

Thyroid:

Thyroid is a small butterfly shaped gland located in the lower region at the front portion of the neck. The gland rich in numerous blood vessels secrets quite a few number of hormones, called thyroid hormones of which thyroxine also known as T4 plays a major role. Its functioning includes metabolic growth, maintaining proper body temperature and plays a pivotal role in brain development in the childhood.

The thyroid disorders can range from excessive or minimal secretions of hormones, harmless goitre or thyroid cancer. An endocrine surgeon may recommend various invasive treatments depending on the severity of the condition, mostly to prevent various chronic ailments and to better the quality of life.

• Hemithyroidectomy:Hemithyroidectomy also known as unilateral thyroid lobectomy involves partial removal of thyroid gland and is recommended to assess the suspicious thyroid nodules and also as a part of biopsy in case of thyroid cancer.
• Total Thyroidectomy:A total thyroidectomy involves complete removal of thyroid gland and is done if a patient is diagnosed with thyroid cancer, multinodular goitre, graves disease, substernal/retrosternal goitre, Hashimoto thyroiditis in rare cases.
• Total Thyroidectomy Plus Dissection of Central Compartment Lymph Node:In this procedure the lymph nodes in and around the thyroid gland between the two carotid arteries are removed along with the gland, mostly in cases of thyroid cancer.It is a strategic treatment to reduce the risk of cancer relapse and also accurately decide upon the stage of cancer.
• Total Thyroidectomy and Neck Dissection:Known either as modified radical neck dissection or functional neck dissection, this procedure involves the removal of lymph nodes in the lateral compartment of the neck, to clear the tumor cells. It is often performed along with Total Thyroidectomy as a part of treatment and also to facilitate radio iodine therapy.
• Endoscopic Thyroidectomy:Endoscopic thyroidectomy surgery is an advanced procedure in which smaller incisions are made in the neck, axilla or the chest through which a small camera is inserted for effective removal of small nodules. This scarless procedure facilitates quick recovery, post-surgery.
• Mediastinal Lymph Node Dissection:Mediastinal lymph node dissection (MLND) is more of a diagnostic procedure and it is rarely done in case of thyroid cancers mostly to ascertain the stage of tumour and also to possibly make decisions post-surgery besides achieving better locoregional control and to ensure longevity of the patient.

Parathyroid Procedures:

• Parathyroid Glands:Parathyroid glands are four tiny glands of the endocrine system which play a major role in regulating the levels of calcium and phosphorous in our blood stream. Located in the neck behind the thyroid these glands which are usually a size of a rice grain constantly monitor the calcium levels in our body by secreting a hormone called Parathyroid Hormone (PTH). If the glands secrete excessive or very minimal amounts of hormone, it can cause a major disruption in bodily functions.
• Minimally invasive / Focussed Parathyroidectomy:Minimally invasive parathyroidectomy is done through making a small incision of up to 2 to 2.5 cm for focused exploration or removal of a single abnormal parathyroid gland. Most patients with primary hyperparathyroidism present with only one abnormal gland and in this procedure only the hyperactive gland gets removed, after running pre-operative tests like sestamibi scan and an ultrasound.
• Classical Four Gland Exploration:Classical Four Gland Exploration is done through making a 4 cm incision, through which a macroscopic exam is done to assess the abnormality of each gland. The surgeon may then remove one or more abnormal glands, depending on the severity.
• Three and Half Gland Parathyroidectomy:In few cases, all the 4 parathyroid glands can get enlarged (parathyroid hyperplasia) and in such condition, the surgeon remove three-and-half-glands, leaving a half a gland intact, for maintaining normal calcium levels in the blood.
• Total 4 Gland Parathyroidectomy:Total 4 Gland Parathyroidectomy is done in rarest of the rare cases like neonatal severe hyperparathyroidism in which all 4 parathyroid glands along with supernumerary glands

Thymus Procedures:

• Thymus:Thymus is a primary lymphoid organ which produces progenitor cells which later mature into T-cells (thymus derived cells), which plays a crucial role in destroying infected or cancerous cells. It is secreted by the thymus for aiding other organs in the immune system to grow and function properly.
• Transcervical Thymectomy:A Transcervical Thymectomy is an invasive procedure in which the thymus gland located in the front portion of the chest (anterior mediastinum) with “finger-like” extensions into the neck and consists of multiple lobes (two to five or more) is removed.The procedure involves removal of the thymus by making a horizontal incision across the lower neck. It is often combined with 3 and half gland or total parathyroidectomy in case of multiglandular involvement or in multiple endocrine neoplasia type 1.
• Endoscopic Parathyroidectomy:Endoscopic Parathyroidectomy is done through making two or three small incision less than 2 cm in length in the front portion of the neck, just above the breastbone. It is done to eliminate diseased parathyroid glands and is video-assisted to give a better view to the surgeon.
• Parathyroid Auto-transplantation:Parathyroid Auto-transplantation is done by removing the parathyroid tissue and relocating it into the muscle of either neck or forearm. This is often done as a preventive step in case of thyroid cancer and secondary hyperparathyroidism or re-operative and thyroid and parathyroid surgery in multiple endocrine neoplasia type 1. The tissue is removed very safely under local anaesthesia and is a risk-free procedure.

Adrenal Gland:

• Adrenal Gland Procedures:Adrenal or suprarenal glands are located above the kidneys and their main function is the production of adrenaline hormone and steroids aldosterone and cortisol. The adrenal cortex that is divided into three zones produces steroid hormones, mineralocorticoids, glucocorticoids, androngens which are responsible for a wide range of functions right from maintaining blood pressure, electrolyte balance, metabolism, immune system etc.A majority of endocrine related diseases are caused due to the dysfunction of adrenal gland and in few cases tumours ranging from adrenal tissue can get detected in medical imaging during the diagnosis of other health conditions.Dealing with diseases related adrenal gland require a advanced medical care and expertise. Below are the procedures and treatments offered.
• Laparoscopic Adrenalectomy:Laparoscopic adrenalectomy is the first line of treatment and procedure while handling benign (non-cancerous) adrenal tumours. During the procedure, the surgeon will make three to five incisions through which a tiny video chip camera gets inserted via long tubes called ports into the abdomen. The video chip camera flashes the images from inside the abdomen on a television monitor facilitating a clear view for the surgeon to perform the operation.Patients who have had undergone laparoscopic surgery would require shorter period of hospitalization of up to days and would experience rapid recovery rate.
• Open Transperitoneal Adrenalectomy:Open Adrenalectomy is generally preferred to remove large adrenal tumours and is done in the case of adrenal masses that are suspicious to be malignant (cancerous).
• Retroperitoneal Adrenalectomy:During Retroperitoneal Adrenalectomy the patient is made to lie down in prone (face down) and the adrenal glands are accessed through the back. The major advantage in this approach, is that the surgeon need not move any other organs like spleen, liver, pancreas, colon obstructing the view and it is performed much quicker and is advanced compared to traditional transabdominal approach. This is most preferred technique if the patient has to undergo the removal o both adrenal glands.
• Bilateral Adrenalectomy:Bilateral adrenalectomy is an advanced, safe, and a definitive treatment for patients suffering from refractory Cushing disease, bilateral pheochromocytoma or other bilateral adrenal masses. This surgery is performed via a minimally invasive laparoscopic approach for faster recovery.
• Thoracoabdominal Adrenalectomy:The thoracoabdominal Adrenalectomy approach is indicated in very large adrenal masses. Its main advantages include faster ligation and severance of the adrenal vein mobilization of the tumor, and short surgery duration, etc.

Breast:

Breast located on the upper ventral region of the humans, serves as the mammary gland in case of females for feeding milk to the babies. Contrary to the belief that only women develop breasts, men too have it and are developed from the same embryological tissues.

In certain cases, an endocrinology surgeon is required, mostly while treating breast surgery cases.

• Breast Lump Excision:The excision of the lump in breast known as excisional breast biopsy or lumpectomy is an invasive procedure in which the tissue around the affected area or entire lump is removed to check for cancer cells.
• Microdochectomy:Microdochectomy is a regular treatment in case of a nipple discharge oozing out from a single duct (lactiferous duct). It is done in the case of repeated breast abscess and mastitis. However, an incision of the mammary duct without excision is called as microdochotomy.
• Modified Radical Mastectomy:A modified radical mastectomy is usually a first line of procedure in case of breast cancer. During the surgery, the expert removes the entire breast including skin, areola, nipples and lymph nodes in the axillary.
• Breast Conserving Surgery:Breast conserving surgery involves the removal of cancerous tumour leaving the normal breast in place. This surgery is also known as lumpectomy, quadrantectomy, partial mastectomy and segmental mastectomy depending on the tissue removal.
• Sentinel Lymph Node Dissection:The Sentinel Lymph Node Dissection is done by removing only single lymph node and is tested for malignancy. If the node is non-malignant it is diagnosed that the cancer has not spread to other lymph nodes.
• Flap Reconstruction in Breast Cancer:Also known as Autologous Tissue Reconstruction, flap reconstruction in breast cancer is a procedure to reshape the breast after the excision of cancer.
• Pancreas:Pancreas is an organ of both digestive and endocrine system and in the human body it is located in the abdominal region, behind stomach and functions as a gland. The main functions of this endocrine gland include regulating blood sugar levels, secretion of insulin and other major hormones.
• Enucleation of Insulinoma:Insulinoma is medical terms is cancer of pancreas and enucleation is an advanced technique in which the tumour or organ is removed as a whole. This less invasive technique is performed in more than 50 per cent of cases and it is often recommended to the patients with high complication rate.
• Pancreatic Resection:Pancreatic Resection often known as Whipple’s procedure is a surgical procedure to remove pancreas, gallbladder, some portion of bile ducts and a part of small intestine. This major surgery that needs exceptional expert care is performed in the case of pancreatic cancer or tumour affecting other organs in the abdominal region.
• Intraoperative Ultrasonography:Intraoperative Ultrasonography is used both as a diagnostic tool and also in the treatment procedures, in which high-energy sound waves bouncing off the internal organs and tissues reflect sonograms or pictures back on the computer screen for the surgeon to view the accurate position of tumour and also handle other problems that might arise on surgery table.
• Laparoscopic Resection of Pancreatic Mass:Laparoscopic resection of Pancreatic mass is a sophisticated medical technique which ensures very little blood loss and minimal access, mainly for preventing the risk of pancreatic fistula in case of total pancreatomy while treating cancer.