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Endocrine surgery from long incisions to minimally invasive surgery

Endocrine surgery from long incisions to minimally invasive surgery. Nidal Younes MBBSc Professor of endocrine Surgery Secretary General JMC. How Uneducated Butchers and Barbers Became Today’s Skilled Surgeons. British surgeon Robert Liston and the 2-3 min amputation.

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Endocrine surgery from long incisions to minimally invasive surgery

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  1. Endocrine surgery from long incisions to minimally invasive surgery NidalYounesMBBSc Professor of endocrine Surgery Secretary General JMC

  2. How Uneducated Butchers and Barbers Became Today’s Skilled Surgeons

  3. British surgeon Robert Liston and the 2-3 min amputation

  4. Morton Ether Inhaler at the Mass. General in1847

  5. June 17, 1867: Lister Cuts Clean, Saves Lives

  6. The Nobel Prize in Physiology or Medicine 1909 was awarded to Theodor Kocher"for his work on the physiology, pathology and surgery of the thyroid gland

  7. (September 18, 1889 — September 2, 1917

  8. The first parathyroidectomy performed by Felix Mandel in 1925

  9. Laparoscopic surgery • 1975 laparoscopic salpingectomy • 1970-1980 gyneprocedures • 1981 Semm /Germany 1st lap appendectomy • 1989 lap cholecystectomy

  10. Surgery 101. up until the discovery of anesthesia Surgery 102 ..1847- 1990s traditional surgery Surgery 103 from 1990s MIS

  11. Scope of laparoscopic surgery • Cholecystectomy • Appendectomy • Adrenalectomy • Colectomy • Hernioplasty • Diagnostic • Hiatus Hernia repair • Bariatric surgery • Adhesiolysis

  12. Advantages of Lap Surgery • Day care surgery • Shorter hospital stay • Improved cosmesis • Faster recovery • Minimal pain • Small scar • Better preservation of respiratory function

  13. The Art of surgery Clinical judgment Knowledge Dexterity

  14. Surgical management requires • localization • Access • Surg procedure

  15. Minimally invasive thyroid surgery • Minimally invasive video-assisted thyroidectomy (MIVAT) • Totally endoscopic techniques that include an axillary approach, transcervical …

  16. Outcome and prognosis • Better cosmesis • less postoperative pain and discomfort conventional thyroidectomy • shorter hospital stays.

  17. Minimaly inavsive parathyroid surgery Videoendoscopic- co2 insufflations Videoendoscopic- gassless Videoassisted Radioguided Focused central mini incision Focused lateral mini incision

  18. Targeted /minimally invasive surgery Preoperative localizing techniques U/S CT Sestamibi Spect CT MRI

  19. Targeted Vs bilateral exploration RTCs comparing routine bilateral exploration vs limited exploration guided by IOPTH, show that bilateral exploration leads to the unnecessary removal of additional non-hypersecreting parathyroid glands Siperstein A, Prospective evaluation of sestamibi scan, ultrasonography, and rapid PTH to predict the success of limited exploration for sporadic primary hyperparathyroidism, Surgery 2004 Miccoli P, Endoscopic bilateral neck exploration versus quick intraoperativ e parathormone assay (qPTHa) during endoscopic parathyroidectomy: A prospective randomized trial, Surgery 1999

  20. Minimally invasive parathyroid surgery

  21. Indications for adrenalectomy • Incidentalomas • Primary hyperaldosteronism • Cushing syndrome • Pheochromocytoma • Neuroblastoma • Adrenocortical carcinoma • During surgery for RCC

  22. DDx adrenal mass • Cortical vs Medullary • Benign vs malignant • Functioning vs non functioning • Primary vs secondary

  23. Adrenal tumors • Conn’s syndrome • Cushing's syndrome • Pheochromocytoma • Neuroblastoma 30% adrenal • Virilizing or feminizing syndromes • Myelolipoma • ACC (1 case per 1.7 million)

  24. Conn’s syndrome • A 25 y male presents to the clinic as a new patient. He takes no prescription medications, over-the-counter products or “alternative substances” • He came because his wife, a PA, noted hypertension and scheduled the visit • Lab results revealed K=2.9

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