Surgical Department of the Endocrine Glands

Endocrine gland surgery with clinicisation up to one day

Which are the endocrine glands?

The endocrine glands are organs that have the role of producing hormones and secreting them into the bloodstream for action elsewhere in the body. The most important endocrine glands in the body are: the pituitary gland, the thyroid gland, the parathyroid glands (usually 4), the adrenal glands (left and right) and the endocrine pancreas

Conditions for applying clinicisation of less than one day

The surgical treatment of endocrine gland diseases with clinicisation of less than one day requires a number of conditions. Three are the most important factors in its implementation: (1) the appropriate patient, (2) a familiar surgical team, and (3) a certified and organized clinic institution.

More specifically, the outdated concept of the surgeon is being replaced by that of the surgical team, which must be familiar with one -day surgery and have a high volume of patients. The existence of a team makes it possible to have the constant presence of the attending surgeons (both inside and outside the clinic), thus reducing complications and unfortunate events, conditions essential for this type of surgery.

The clinic must be accredited for standard high-quality services and have the appropriate nursing and administrative structures to support this type of fast-track surgery. In addition, respect for the sick person and his or her individuality is the main factor in optimising the service and care provided. Finally, the necessary materials must be available on a daily basis and according to the needs, in order to avoid any delays and any diversion from the ideal operation.

Finally, all patients are not eligible for short clinicisation (less than 24 hours). Eligibility criteria are mainly commensurate with the affected endocrine gland, underlying comorbidities, expertise and also the experience of the surgical team.

What are the benefits of fast-tracked endocrine surgery?

The benefits of fast-track endocrine surgery are seen at three levels: (i) personal for the patient, (ii) financial for the patient and the fund, and (iii) social.

In particular, the patient with this type of surgical treatment has a high feeling of satisfaction (very often reaching the level of surprise), which is the result of a multitude of factors. Flexibility in planning is noted by the patient, accompanied by a minimisation of pain, clinicisation and recovery time, resulting in a rapid return to daily activities.

In addition, surgery with clinicisation of less than 24 hours is characterised by lower costs, which are divided into three components: (i) reduced financial participation by the patient (both directly and indirectly), (ii) reduced overall costs for the fund, and (iii) faster reintegration into the work environment.

Which endocrine gland procedures can be performed with a clinic stay of one day or less?

Minimally invasive fast track surgery of the endocrine glands with mainly concerns the thyroid gland and parathyroid glands, but also, on a secondary basis, the adrenal glands. It is a combination of techniques designed to significantly reduce the morbidity of operations involving these glands, but also to improve the final aesthetic result.

The thyroid gland is always removed with a short clinic stay (<24 hours), whether it is lobectomy, total thyroidectomy, central compartment lymph node dissection or lateral compartment lymph node dissection.

Surgery of the parathyroid glands whether removed alone (in case of solitary adenoma) or removed in their entirety (in case of secondary hyperparathyroidism), or when investigation is required (in case of unlocalized adenoma) is presumably performed with a short clinicisation.

Finally, laparoscopic adrenalectomy has an average clinic stay of one day.

Who should do the surgery?

Thyroidectomy (total or not) historically belongs to the wide range of surgical procedures, but the specificity of this delicate operation and the severity of potential complications have forced the overspecialization in endocrine gland surgery. Officially, therefore, any surgeon can perform a thyroidectomy, but it is the qualified surgeon or, even better, the qualified surgical team that will achieve the optimal aesthetic result, with the lowest number of complications and the lowest probability of disease recurrence and reoperation.

Is there anything new in thyroid and parathyroid surgery?

Thyroidectomy is unfortunately still performed today in various ways and one often encounters the traditional technique (Kocher 1909) with large incisions, drainage and several day recovery.

Surgical teams specialised in endocrine surgery apply minimally invasive techniques (classical or remote), which – depending on the indications – include the use loupes or a camera. The magnification offered by these two instruments drastically reduces complications. At the end of the operation, no drainage is placed. The patient can speak directly and can eat normally 3 hours after surgery. The next day the patient is discharged and is able to return to daily activities and concerns.

At this point it is worth noting the existence and use of radio frequency or ultrasonic scanners that provide maximum accuracy and effectiveness. Their use significantly reduces tissue damage and operating time. Finally, in cases of recurrences or major thyroid oncological operations, the use of neuromonitoring increases the protection of the laryngeal nerves and vocalizing especially in inexperienced surgeons.

Quality is the preponderance of a service

Quality is the differentiating factor as well as the key to optimising resources and reducing costs.

In the Surgical Department of Endocrine Glands we have set as objectives:

Adherence to high standards in the medical services provided
The satisfaction of the patient and his/her family environment
The integration of morality and ethics in all operations
Respect for human beings and their individuality
The eradication of complications
The philosophy of minimum clinicisation
Innovation and continuous improvement of the services provided
The use of techniques and methods that help in making critical decisions
Successful communication with the associate physicians

Minimally invasive surgery: A challenge for the surgeon, a balm for the patient

The difference between modern surgery and classical surgery is qualitative in the broad sense of the term, since quality is the preponderance of a service. In this case, modern surgery (presumably minimally invasive) is a medical practice that is both technologically and qualitatively upgraded. To achieve the desired outcome, the surgical team must be governed by the quality assurance triad including (1) commitment, (2) participation and (3) knowledge. This ensures optimisation of surgical outcome (in terms of prognosis, morbidity, complications and mortality), better use of resources and reduction of costs.

For the success of the best clinical and surgical outcome, the cooperation of the entire treatment team is essential, including not only surgeons, but also the doctor who has made the initial approach and the doctors who will follow the patient postoperatively (pathologists, oncologists, endocrinologists, imaging specialists, pathologists, nuclear physicians and any other specialty deemed necessary in each case.

Surgical Department of the Endocrine Glands

The surgeons: Theodosis Papavramidis, Ioannis Pliakos, Moisis, Moisidis

The anesthesiologist: Georgios Kotsovolis