Greenville Health System (GHS) is the busiest endocrine surgery center in the state.
GHS is relatively unique in having two fellowship-trained endocrine surgeons on staff to care for patients with thyroid, parathyroid, adrenal and other endocrine health problem
“Endocrine surgery is a very new, rare specialty, and while there is no board certification for it so far, there is formal fellowship training.”
Jonathan Lokey, M.D., FACS
Wendy Cornett, M.D., MHS, FACS and Jonathan Lokey, M.D., FACS, both of GHS (the GHS multispecialty physician group practice), are two of 190 active U.S. members listed by the American Association of Endocrine Surgeons. Endocrine surgeons are located primarily at large medical centers. There are three other practicing endocrine surgeons in South Carolina; Drs. Cornett and Lokey are the only fellowship- trained endocrine surgeons in the Upstate. The expertise of our surgeons in performing thyroid surgery and other endocrine surgery procedures draws patients from Greenville, Asheville, Columbia, and areas throughout the Southeast. The division is very busy, performing about 500 thyroid and parathyroid surgeries a year – more than any other medical center in the state.
Minimal Access PerspectivesThe endocrine surgery specialists at GHS use advanced procedures and the latest technology to help ensure less pain, earlier postoperative recovery and shorter hospital stays for their patients. GHS was one of the first medical centers in the Upstate to offer minimal access parathyroid surgery and one of the first in the state to do laparoscopic adrenalectomy and laparoscopic endocrine pancreatic surgery, according to Dr. Lokey.
Drs. Cornett and Lokey perform most parathyroid and adrenal surgeries with minimally invasive surgery techniques. Adrenal surgery is performed laparoscopically, using several small incisions to accommodate a camera and other instruments. For adrenalectomies, the minimally invasive technique is less painful than the traditional open procedure, and the patient can go home much earlier.
For thyroid surgeries, the advantage of a minimally invasive technique is not as certain, and very few patients requiring thyroid surgery are suitable candidates for video-assisted thyroidectomy. “The incision is only one centimeter shorter, and the scar may or may not look better,” said Dr. Lokey.
In most cases, the thyroid is too big to be removed through a small incision, and so the majority of GHS patients (75 percent) have an open thyroid surgery procedure that results in minimal pain and an overnight hospital stay.
Technological InnovationsGHS was the first hospital system in the state and one of the first in the country to use intraoperative parathyroid hormone (PTH) monitoring for parathyroidectomies. This procedure, performed with assistance from a laboratory technologist in the OR, involves the collection and testing of PTH before surgery and just after removal of the parathyroid. While this testing requires a great deal of coordination between a hospital’s surgical and laboratory staff, by checking PTH levels in this way, the surgeon can better verify the success of the procedure while still in the OR.
Another example of an endocrine surgery technology implementation that improves quality is the use of laryngeal nerve monitoring in select cases to help reduce the risk of injury to the laryngeal nerve, a major complication in thyroid and parathyroid surgery.Drs. Cornett and Lokey are testing an updated, more ergonomic version of the harmonic scalpel, which can decrease blood loss and operating time and speed recovery. “We are analyzing data from 200 cases for a prospective clinical trial,” Dr. Lokey said. The analysis compares surgical results from procedures performed using the new harmonic scalpel with those from operations performed with the older version of the scalpel.
The endocrine surgery division also is actively involved in academics, usually publishing one to two papers a year. The American Surgeon published one paper analyzing operative findings from 738 thyroid surgeries Dr. Lokey performed at GHS (Am Surg. 2005;71:911-3). The Journal of the American College of Surgeons published highlights of Dr. Cornett’s research on thyrothymic thyroid rests, which are bits of thyroid tissue that migrate during embryology (J Am Coll Surg. 2002;195:635- 40). By better understanding the presence of this tissue, the surgeon knows to look for additional portions of the thyroid in the chest that he or she might otherwise miss during surgery.
Looking to the future, Dr. Lokey said growth in endocrine surgery at GHS promises that the specialty can support a fellowship program. Drs. Cornett and Lokey also are exploring the possibility of forming a multispecialty endocrine center in Greenville, with participation from area endocrinologists, neurosurgeons, otorhinolaryngologists and pediatricians.
For more information on advances in thyroid surgery and other endocrine surgery procedures, or to refer a patient to the Endocrine Surgery Division at GHS, which serves Greenville, Asheville, Columbia, and areas throughout the Southeast, call Drs. Cornett and Lokey at (864) 454-2100.