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Endocrine surgery is one of the newest subspecialties of general surgery. We have analyzed the impact of first endocrine surgery unit on a general surgery department. A retrospective study of all endocrine surgical procedures and research output of a teaching surgical department in India was performed. Data was compared between two 3-year periods: before (Jan 2017–Dec 2019) and after (Jan 2020–Dec 2022) the start of a dedicated endocrine surgery unit. The number of surgeries (thyroid, parathyroid, and adrenal), conference presentations, and publications on endocrine surgery went up significantly (<0.05). In addition, newer minimally invasive techniques like endoscopic thyroid and adrenal surgeries were started and became a regular feature. Advent of a new endocrine surgery unit substantially increased the endocrine surgical volume and academic output in the field of endocrine surgery.

•Background: The Affordable Care Act's Medicaid expansion increased insurance coverage and access to care for endocrine cancers, though impact on benign endocrine disease is unknown. •Methods: Patients undergoing operations for benign thyroid, parathyroid, and adrenal disease were collected from the Vizient® Clinical Data Base from 2009 to 2016 and grouped by state Medicaid expansion status in January 2014. Insurance coverage was analyzed by difference-in-differences analysis, and logistic regression evaluated odds of operation by insurance status. •Results: 134,242 patients were included. Medicaid coverage in expansion states increased for all operations (Adj-DD 5.78%, p < 0.001) with decreases in uninsured and private insurance. Medicaid patients had increased odds of undergoing thyroid operations (OR 1.56, p < 0.001) and decreased odds of parathyroid (OR 0.68, p < 0.001) or adrenal operations (OR 0.70, p < 0.001) versus private insurance. •Conclusion: Medicaid expansion increased insurance coverage for benign endocrine disease, however, barriers remain for Medicaid patients with parathyroid and adrenal disease. •The ACA increased Medicaid coverage for benign endocrine surgical procedures.•Medicaid Expansion states had lower rates of uninsured patients.•Medicaid patients have increased odds of undergoing thyroid operations.•Medicaid patients have lower odds of undergoing parathyroid or adrenal operations.

Background Current guidelines recommend transcervical thymectomy (TCT) during parathyroidectomy (PTX) for Multiple Endocrine Neoplasia Type 1 (MEN1)-associated primary hyperparathyroidism (PHPT) despite limited evidence substantiating efficacy. We aimed to determine the role of TCT in disease control and safety outcomes. Methods A systematic review and meta-analysis were conducted on comparative observational studies exploring the efficacy of PTX with or without concomitant TCT for managing PHPT in patients with MEN1. Pooled event proportions were estimated using Freeman-Tukey double arcsine transformation method and converted to relative risk. Six studies ( n  = 306 patients) were included. Results TCT showed significantly reduced rates of persistent (relative risk 0.15; 21.9% vs. 3.1%; p  < 0.01) and recurrent PHPT (RR 0.34, 43.8% vs. 12.9%; p  = 0.004) necessitating re-operation compared to PTX alone, suggesting improved disease control. Interestingly, the addition of TCT reduced rates of transient PHPT (RR 0.07; 9.3% vs. 0%; p  < 0.01 and permanent recurrent laryngeal nerve injury (RR 0.32, 3.9% vs. 1.0%; p  = 0.04), indicating possible benefits in morbidity. Conclusions Concomitant TCT may improve the safety and efficacy of PTX in MEN1-associated PHPT by synergistically clearing all cervical disease and minimizing adverse sequelae. Our findings provide further evidence to support existing recommendations for TCT and can guide surgical decision-making.

Background Robotic transaxillary (RT) endocrine surgery may improve cosmetic outcomes. We report our initial experience in RT thyroid and parathyroid surgery and the associated learning curve, and compare early surgical outcomes to those of open thyroidectomy (OT) and focal parathyroidectomy (FP). Methods A prospective database review identified patients who had undergone RT endocrine surgery. A case-matched group who underwent OT or FP was also identified. Demographics, histopathology, operative outcomes, and follow-up data were collected. Groups were compared using Student’s t test and the χ 2 test. Results Fifteen RT procedures were performed: 11 RT thyroidectomies (6 total, 5 lobectomies) and 4 RT parathyroidectomies (2 focal, 2 unilateral), representing 5.9% and 2.2% of thyroidectomies and parathyroidectomies performed. The OT group contained 16 patients (13 totals, 3 lobectomies). The FP group contained 12 patients. There was no significant difference in age, gender, BMI, pathology, or complications between the groups. Mean operating time was significantly longer in the RT group (232 vs. 109 min, P  = 0.0002) as was mean incision length (6 vs. 3.6 cm, P  < 0.0001). No RT procedures were converted and no major complications occurred. Operating time decreased significantly over consecutive cases demonstrating a learning curve. Conclusions RT thyroidectomy and parathyroidectomy can be performed safely by specialist endocrine surgeons, early in their learning curve, without an increased complication rate, albeit with significantly longer operating times.

Reoperative adrenalectomy, defined as subsequent ipsilateral adrenal resection, has been incompletely characterized. Utilizing a multi-institutional database, we investigated the outcomes of reoperative compared to primary adrenalectomy. Using The Collaborative Endocrine Surgery Quality Improvement Program (CESQIP), patients undergoing primary and reoperative adrenalectomy were identified. 30-day outcomes were compared using Chi square and Wilcoxon sum tests. Out of 3558 patients, 3469 (97 ​%) had primary and 89 (3 ​%) reoperative adrenalectomy. Indications for adrenalectomy varied between groups, p ​< ​0.01. Reoperative adrenalectomy was associated with longer operative time and length of stay, and higher rates of intra-operative complications and readmission. There was no difference in the 30-day mortality rate between the groups. Reoperative adrenalectomy is uncommon and is associated with increased morbidity. Patients should be counseled regarding possible operative complications. Although reoperation is associated with an extended length of stay and higher likelihood of readmission, there was no detriment to 30-day mortality. •Indications and outcomes associated with reoperative adrenalectomy are incompletely characterized in the literature.•Reoperative adrenalectomy is uncommon and is associated with increased morbidity compared to a primary adrenalectomy.•Patients undergoing reoperative adrenalectomy experienced longer operative time and had higher rates of intra-operative complications.•Reoperative adrenalectomy was associated with an extended length of stay and higher rates of readmission, but no detriment to 30-day mortality.

We sought to determine if endocrine anatomy could be learned with the aid of a hands-on, low-cost, low-fidelity surgical simulation curriculum and pre-emptive 60-second YouTube video clip. A 3-hour endocrine surgery simulation session was held on back-to-back Fridays. A video clip was made available to the 2nd group of learners. A comprehensive 40-point test was administered before (pre-test) and after (post-test) the sessions. General surgery interns (n = 26) participated. The video was viewed 19 times by 80% (12 of 15) of interns with access. Viewers outperformed nonviewers on subsequent post-testing (mean [SD], 29.7 [1.3] vs 24.4 [1.6]; P = .015). Mean scores on the anatomy section of the post-test were higher among viewers than nonviewers (mean [SD] 14.2 [.9] vs 10.3 [1.0]; P = .012). Low-cost simulation models can be used to teach endocrine anatomy. Pre-emptive viewing of a 60-second video may have been a key factor resulting in higher post-test scores compared with controls, suggesting that the video intervention improved the educational effectiveness of the session.

Background and Objectives: Robotic surgery has been widely adopted in general surgery worldwide but access to this technology is still limited to a few hospitals. With the recent introduction of new robotic platforms, several studies reported the feasibility of different surgical procedures. The aim of this systematic review is to highlight the current clinical practice with the new robotic platforms in general surgery. Materials and Methods: A grey literature search was performed on the Internet to identify the available robotic systems. A PRISMA compliant systematic review was conducted for all English articles up to 10 February 2023 searching the following databases: MEDLINE, EMBASE, and Cochrane Library. Clinical outcomes, training process, operating surgeon background, cost-analysis, and specific registries were evaluated. Results: A total of 103 studies were included for qualitative synthesis after the full-text screening. Of the fifteen robotic platforms identified, only seven were adopted in a clinical environment. Out of 4053 patients, 2819 were operated on with a new robotic device. Hepatopancreatobiliary surgery specialty performed the majority of procedures, and the most performed procedure was cholecystectomy. Globally, 109 emergency surgeries were reported. Concerning the training process, only 45 papers reported the background of the operating surgeon, and only 28 papers described the training process on the surgical platform. Only one cost-analysis compared a new robot to the existing reference. Two manufacturers promoted a specific registry to collect clinical outcomes. Conclusions: This systematic review highlights the feasibility of most surgical procedures in general surgery using the new robotic platforms. Adoption of these new devices in general surgery is constantly growing with the extension of regulatory approvals. Standardization of the training process and the assessment of skills’ transferability is still lacking. Further studies are required to better understand the real clinical and economical benefit.

Many patients with Medullary Thyroid Cancer (MTC) will have persistent or recurrent disease after surgery requiring lifelong surveillance with imaging and tumor markers. The objective of this study is to evaluate the efficacy of 68Ga-DOTATATE-PET (or 68Ga labelled equivalent radiopharmaceutical) versus 18F-FDG-PET for detecting persistent and/or metastatic recurrent MTC. Relevant studies were identified by conducting searches in Embase and PubMed and five studies were included in the final review. Five studies investigated per-patient sensitivity of 18F-FDG-PET and 68Ga-DOTATATE-PET in MTC patients. Four studies investigated the correlation between calcitonin and number of lesions detected by 18F-FDG-PET and 68Ga-DOTATATE-PET, and three investigated the correlation between CEA and number of lesions detected by 18F-FDG-PET and 68Ga-DOTATATE-PET. There was no significant difference in number of lesions detected by 18F-FDG -PET compared with 68Ga-DOTATATE-PET. When compared directly to 18F-FDG-PET, there is a general trend towards favoring 68Ga-DOTATATE-PET in per-patient sensitivities, and incidence of lesion detection. •68Ga-DOTATATE-PET has a role in imaging MTC patients with suspected recurrence.•68Ga-DOTATATE-PET may be complementary to 18F-FDG-PET when imaging MTC patients for recurrence.•The cost and technicalities of 68Ga-DOTATATE-PET should be considered.

Adrenocortical carcinoma (ACC) is an aggressive, rare malignancy. 2-deoxy-2-[18F]-fluoro-d-glucose positron emission tomography (FDG-PET) assesses tumor metabolism and glucose utilization. We hypothesized that higher maximum standard uptake value (SUVmax) is associated with decreased survival. We performed a retrospective analysis of patients with ACC. Included patients (n = 26) had an FDG-PET scan available with a documentable SUVmax. Patients were dichotomized into “High” (≥8.4, n = 12) and “Low” (<8.4, n = 14) SUVmax. Univariate analysis and survival analysis were performed to compare groups. Demographics between groups were equivalent. The high SUVmax cohort demonstrated lower survival (median 479 days or 15.7 months) compared to the low group (median 1490 days or 48.6 months, p = .01). Log-Rank curve confirmed differences in survival (p = .007). Higher SUVmax was associated with significantly worse survival in ACC and may reflect a more aggressive phenotype. FDG-PET may provide clinically useful information to determine prognosis and treatment. Further studies should prospectively evaluate using FDG-PET/CT in ACC. [Display omitted] •Adrenocortical carcinoma is a rare aggressive tumor that has a high rate of glucose utilization and is thus frequently FDG-avid on PET scan.•We found that higher SUVmax of ACC tumors on PET scan was associated with worse overall survival.•FDG-PET may be a useful adjunct in the work up and management in patients with known or suspected ACC.