Endocrine surgery is a surgical sub-speciality focusing on surgery of the endocrine glands, including the thyroid gland, the parathyroid glands, the adrenal glands, glands of the endocrine pancreas, and some neuroendocrine glands.
Surgery of the thyroid gland constitutes the bulk of endocrine surgical procedures worldwide. This may be done for a variety of conditions, ranging from benign multinodular goiter to thyroid cancer.
Operations involve removal of the thyroid gland (thyroidectomy) 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.
Removal of the parathyroid gland(s) is referred to as parathyroidectomy, usually performed for primary hyperparathyroidism.
adrenalectomy, i.e surgical removal of the adrenal gland is done in conditions like Conn syndrome, pheochromocytoma, adreno-cortical cancer etc.
DIseases of the endocrine pancreas occur very infrequently; these include insulinomas, gastrinomas etc. Surgery for these conditions range from simple tumor enucleation to more larger resections.
History and training
Endocrine surgery is in general more recently developed than other fields of surgery.
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. Beginning in 1978, specialty training became available in the United Kingdom and later in the USA to help train surgeons within this highly specialized field.The early training center was the Hammersmith Hospital London where under the guidance of Professor Dick Welbourne and Mr John Lynn a large number of Endocrine Surgeons were trained. 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. This results in a high risk of permanent voice change (up to 2%) and a high risk of parathyroid damage. In expert hands these risks should be nearer 0.5%.Permanent damage to both voice box nerves is an extreme rarity and needs in most cases a permanent tracheotomy.