The function of our hormones is vital to good health. Imbalances can lead to thyroid problems, diabetes and a number of other related disorders. But it is the glands or endocrine system that influences how well our body produces hormones.
Endocrine surgery is a subspeciality area of general surgery. It involves surgery of the thyroid, parathyroid and adrenal glands. These glands all produce hormones and surgery can be required when these glands are diseased and produce an excess of hormones, or in cases where cancer is suspected.
Dr Chris O’Neill, specialist surgeon in Newcastle, completed her general surgical training in Newcastle in 2008. She spent 2 years specialising in endocrine surgery and completed a Masters of Surgery in thyroid cancer genetics. She is widely published in endocrine surgery and is at the forefront of the latest techniques in laparoscopic adrenal surgery, which enables patients to benefit from a quicker and less painful recovery from operations.
She explains that advances in surgical approaches means that procedures within endocrine surgery are now less invasive.
“Trends in endocrine surgery are towards more minimally invasive surgery. This involves different surgical approaches with smaller incisions. The surgery is just as safe but patients recover much faster”.
“The majority of patients who undergo thyroid, parathyroid or adrenal surgery now stay in hospital only one to two nights and are back at work within a week or two”.
The operation Dr O’ Neill is referring to offers a much more direct approach, performed from the back (under the rib cage). Patients who undergo this type of surgery experience much less pain post-operatively. Dr O’Neill is the only surgeon in the Hunter to offer this approach for adrenal surgery.
The adrenal glands lie on top of the kidneys and nodules are frequently detected with imaging. Most adrenal nodules do not require surgery however if adrenal surgery is required it is usually performed as a keyhole procedure.
One of the most common issues Dr O’Neill treats is nodules of the thyroid, which for 5 per cent of the population are seen as a lump at the front of the neck. The widespread use of imaging has also led to an increased rate of detection of less visible nodules, with up to 50 per cent of the population having thyroid nodules that can be seen on imaging.
It’s not uncommon for a patient having a CT of the spine to have a thyroid nodule detected. Thyroid nodules are best assessed with ultrasound and the majority need no further investigation or treatment. These ultrasounds are increasingly being performed by surgeons and endocrinologists. Dr O’Neill uses an ultrasound in the assessment of patients and in the operating theatre.
For patients having thyroid and parathyroid surgery, scarring can be a major concern as the glands are located in the front of the neck. When suitable, minimally invasive surgery incisions are only 2-3cm in length and cosmesis is generally excellent. Even when larger incisions are required these can usually be hidden in pre-existing skin creases.
Thyroid nodules that require surgery are those that are may be thyroid cancer or that are large enough to cause pressure in the neck. This pressure results in problems with swallowing, breathing or voice change.
Thyroid cancer is being diagnosed much more frequently worldwide, partly due to increased detection from imaging undertaken for other reasons. Most patients undergo surgery and some require radioactive iodine. Treatment of thyroid cancer rarely requires traditional chemotherapy and radiation. After treatment, the majority of patients with thyroid cancer have a normal life expectancy.
Parathyroid disease leads to high calcium levels in the blood stream. It can be associated with osteoporosis and kidney stones. 85% of patients with parathyroid disease are suitable for minimally invasive surgery and 95% of these will be cured by their operation.
Chris is the network supervisor for general surgical training in Newcastle, Chair of the Endocrine Surgery Multidisciplinary meeting and a mother of 3. Patients (public and private) can consult with Chris at Surgery Central, Lake Macquarie Medical Specialist Centre, 4947 8177. She operates at John Hunter, Belmont, Lake Macquarie Private and Lingard Private Hospitals.