New Approach to Endocrine Surgery

Hedwig Bischoff of New Bern, NC, had so many symptoms she couldn’t decide which were the worst. The pain or the hot flashes? The racing heartbeat, fluctuating blood pressure, or wild mood swings?

“My husband didn’t know who he was living with,” says Bischoff, 68. “He never knew if he was going to wake up to the smiling wife or the other one.”

She sought help at Duke Health, where physicians discovered a tumor on one of her adrenal glands. In July 2013, Bischoff had surgery by Sanziana Roman, MD, to remove the tumor.

The effects were immediate. Her symptoms vanished. Just as remarkably, she was back on her feet in almost no time, with virtually no postoperative pain or complications.

“I feel fantastic,” she says. “It’s been less than a month, and I almost can’t tell that I just had surgery. People can’t believe how quickly I’ve recuperated.”

That rapid rebound is one of the hallmarks of a new minimally invasive approach to adrenal gland surgery adopted at Duke under the chief of endocrine surgery, Julie Ann Sosa, MD.

The procedure (known as posterior retroperitoneoscopic adrenalectomy), resembles the standard technique (laparoscopic adrenalectomy), in that it is performed through three or four very small incisions. The difference is where those incisions are made: while traditional laparoscopic adrenalectomies are done through the abdomen, the new approach reaches the adrenal glands through the back. Duke is one of just a handful of institutions that have begun using the new method.

The new approach to adrenal gland surgery is just one of the many initiatives Sosa and her partners, Randall Scheri, MD, and Roman, have launched since Sosa and Roman arrived at Duke. They also implemented a minimally invasive surgical procedure to treat a common disease called primary hyperparathyroidism. Under Sosa’s leadership, Duke is now developing its first clinical trials to evaluate what are called “small molecule” drug therapies for thyroid cancer, which has seen an explosive increase in incidence worldwide.

If the endocrine surgery section seems to be in a flurry of activity these days, Sosa says, that is due in large part to the strong tradition she inherited from prominent Duke endocrine surgeons such as Samuel Wells, MD, and George Leight, MD.

“There’s a huge history here,” says Sosa. “And this is a very exciting time. We have three full-time very experienced endocrine surgeons, so we’re rapidly becoming one of the largest and busiest endocrine surgery and endocrine neoplasia centers in North America.”