Endocrine surgery is a branch of general surgery that deals with endocrine gland surgery. This requires special attention and knowledge of hormonal mechanisms. Surgeons should therefore know about endocrinology, but at the same time collaborate with the endocrinologist. This is a type of surgery that can involve the direct removal of the endocrine gland, for example in the case of the production of an excess of hormones; sometimes it can be directed to the removal of the target organ, where it is not possible to remove the hyperfunctioning. Finally, it also treats benign or malignant tumour disease of the endocrine glands. Not all glands get sick with the same frequency; in our experience we treat thyroid diseases more frequently, then parathyroid and adrenal gland diseases come in order of frequency, and finally those of the endocrine part of the pancreas.
WHAT’S CHANGED IN THYROID SURGERY?
- Stronger indicators for the need to perform thyroid gland surgery, as a result fewer and fewer patients are operated on than in the past. For example, the presence of nodules with benign characteristics or small sized nodules is no longer an indication for surgery;
- Less surgical aggressiveness in case of non-aggressive, non-local advanced malignant tumours, which translates into a tendency to avoid unnecessary demolition surgery;
- Use of new technologies in surgical dissection, that make the operation more accurate and effective but safe at the same time
- The possibility of using a device that allows the monitoring of laryngeal nerves (Nerve Intraoperative Monitoring – NIM) with both intermittent and continuous techniques, in order to prevent iatrogenic injury of nerve structures, a feared complication of thyroid surgery.
In recent years, robotic technology has progressed, even in the field of thyroid surgery: the experiences described differ in the different access to the thyroid region, either through a trans-axillary (unilateral) or through the vestibule of the mouth. It is a type of surgical approach with very narrow indications, therefore addressed to carefully selected patients, which has added, as for all surgical procedures, unique complications which are not present in the traditional technique. It represents, without doubt, a type of surgery with a significant financial impact given the current costs of robotic technology.