Minimally invasive endocrine surgery

Types of thyroidectomy

• Thyroid lobectomy: Removing half of the butterfly shaped gland
• Thyroid lobectomy and isthmusectomy: Removing half of the gland and the middle part of the gland
• Near-total or total thyroidectomy: Removing the entire gland
• Subtotal thyroidectomy: Leaves behind a part of the thyroid gland
• Minimally invasive thyroidectomy: Thyroidectomy performed through a very small incision
• Endoscopic video-assisted thyroidectomy: Thyroidectomy performed through several very small incisions, aided by a small camera inserted into the neck
• Total endoscopic thyroidectomy

Minimally invasive parathyroidectomy (MIP)

This procedure is possible only if preoperative imaging (sestamibi and/or ultrasound) identifies a single abnormal parathyroid gland in the neck. A small incision (1 to 2 inches) is made in the front of the neck. Minimal dissection is done to expose and remove the gland. The surgery can be performed under locoregional anesthesia, if desired. Intraoperative PTH monitoring is used to confirm removal of all hyperfunctioning parathyroid tissue.

Intraoperative PTH (IOPTH)

The intraoperative PTH assay measures PTH levels during parathyroid surgery. Blood is obtained from a vein or artery during surgery and analyzed in the operating room laboratory. After the overactive parathyroid gland(s) are removed, the circulating PTH levels will drop (see graph), and the surgeon will conclude the operation. It has an over 95% accuracy rate in predicting operative success.

If the levels do not drop appropriately during the case, the surgeon will continue to search for additional abnormal glands by performing a conventional four gland exploration.

Adrenalectomy

This is a surgical procedure to remove the adrenal gland(s). Most small adrenal masses can be removed laparoscopically. However, larger masses and those that are suspicious for cancer are removed via open surgery.