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

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

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

7. Morton Ether Inhaler at the Mass. General in1847

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

10. 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

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

12. The first parathyroidectomy performed by Felix Mandel in 1925

14. Laparoscopic surgery 1975 laparoscopic salpingectomy
gyneprocedures
1981 Semm /Germany 1st lap appendectomy
1989 lap cholecystectomy

16. Surgery 101. up until the discovery of anesthesia
Surgery s traditional surgery
Surgery 103 from 1990s MIS

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

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

19. The Art of surgery
Clinical judgment
Knowledge
Dexterity

20. Surgical management requires
localization
Access
Surg procedure

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

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

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

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

28. 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

30. Minimally invasive parathyroid surgery

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

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

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

45. 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

52. Pheochromocytoma

53. Adrenocortical carcinoma
Functioning
Cushing's syndrome
Conn’s syndrome
Pheochromocytoma
Virilizing or feminizing syndromes
Non Functioning

54. Adrenocortical tumors
Carcinomas are typically >18 units Hounsfield
 In-phase/opposed-phase, MRIs.
benign lesions show a loss of signal intensity
malignant lesions show no loss of signal
Extra adrenal extension 

55. ACC incidence is 1 in 1.7 million.
Incidence of CA in incidentaloma 0%-25%.
Adrenocortical carcinomas are large with irregular borders on CT 
By the time they are found, they are usually 12 cm in diameter.
Over 90% of adrenocortical carcinomas are >6 cm at presentation.

57. Transaxillary incisions
Neck collar incision
Small incisions
Endoscopic
Robotic
Transaxillary incisions
Transoral incisons

58. ROBOTIC SURGERY

59. Minirobots
Minicrab-like robots

60. NanoRobots

61. Transoral endoscopic thyroidectomy: A case report
Vishwanath M. Pai et al International Journal of Surgery Case Reports Volume 12, 2015, Pages 99–101

62. Surgery before anesthesia

63. Surgery after anesthesia

64. Operating Room with no People
SRI International, Menlo Park, CA January, 2007