The Endocrine Surgery Department offers diagnostic testing, comprehensive treatment options and services including:
Ultrasound or ultrasound-guided fine needle aspiration biopsy
Interpretation of the following:
- Radioiodine nuclear scans
- CT scans
- MRI scans
- PET (positron emission tomography) imaging
Surgery for diseases of the thyroid and parathyroid glands, including complex and re-operative neck surgery
Minimally invasive surgery options:
- Laparoscopic adrenalectomy
- Robotic adrenalectomy
- Laparoscopic pancreas surgery
- Laparoscopic liver radiofrequency thermal ablation
- Robotic Surgery (including adrenalectomies and “scarless” thyroidectomies)
Robotic Thyroidectomy & Parathyroidectomy
Is a scarless Robotic Thyroidectomy or Parathyroidectomy right for me?»
Patients who need their thyroid or parathyroid removed now have a new surgical option at Cleveland Clinic: Scarless robotic thyroidectomy or parathyroidectomy. When thyroid nodules or parathyroid adenomas must be surgically removed, Cleveland Clinic’s Thyroid Center is the only center in Ohio, and among a handful nationwide, offering robotic thyroidectomy and parathyroidectomy. This new minimally invasive surgical procedure removes all or part of the gland and eliminates the need for an incision in the neck. In contrast, open surgery typically leaves a 4- to 6- cm scar and other minimally invasive approaches leave a 2- to 3-cm scar on the neck.
How does the robotic procedure work?»
You will first be given a general anesthesia to relax your muscles, prevent pain and make you fall asleep. A robotic thyroidectomy or parathyroidectomy is performed through a 5- to 6-cm incision in the armpit. Your surgeon might remove part of the thyroid (lobectomy) or all of the thyroid (total thyroidectomy). If you have a parathyroid adenoma, it will be removed through the same type of incision.
After the surgery
- This is an outpatient procedure. For precautionary reasons, plan on remaining in the hospital for 23 hours.
- There will be no scar on the front of your neck.
- As with any surgery to remove the thyroid, you may need to take thyroid hormone medication after robotic thyroidectomy.
About the da Vinci robot»
da Vinci® Surgical System
The da Vinci® Surgical System allows surgeons to perform minimally invasive surgery with the help of four thin robotic “arms” inserted into strategically placed incisions. The surgeon operates while seated at a console unit, using hand and foot controls. The system’s 3-D, high-definition view of the surgical field simulates the open surgical environment without the physical trauma of large incisions. Use of the da Vinci robot also improves surgical precision, potentially reducing blood loss.
The surgeon controls every movement of the robotic arms, which grasp and place instruments wherever they are directed. The robotic arm’s “wrist” movements mimic those of the surgeon. However, they may be more precise than natural movements because they remain steady at all times, making it easier to manipulate and work from all kinds of difficult-to-reach positions. The surgeon is in full control of the robotic arms during the entire operation, so there is no chance of random movement.
What are the benefits of robotic surgery?
The benefits of robotic procedures include being able to remove the thyroid or parathyroid without leaving a scar on the neck, and improved surgical precision. Initial studies have shown a decreased incidence of hypocalcemia (low calcium) and less swallowing discomfort in patients who had robotic thyroidectomy versus patients who had open thyroid surgery.
Am I a candidate for robotic surgery?»
- Robotic thyroidectomy currently works best for patients who are not overweight, and who have a smaller thyroid gland (4 cm at the largest) and smaller nodules (2 to 3 cm at the largest). Patients with thyroiditis and Graves’ disease are excluded due to inflammation involving the thyroid gland.
- Robotic parathyroidectomy currently works best for patients who are not overweight and who have a single parathyroid adenoma shown on preoperative sestamibi scan and/or neck ultrasound.
- Patients with a history of bad wound healing (keloid formation) are also candidates for robotic surgery. Your endocrine surgeon will help determine the best option for you.
Cleveland Clinic’s Thyroid Center, located within the Endocrinology & Metabolism Institute, is a national leader in caring for patients with all types of thyroid conditions, from the routine to the complex. Our high-volume center is the home of the largest thyroid cancer surgical program in Ohio and the five surrounding states. All the specialists you need — including endocrinologists, surgeons and a full nursing staff — work together as a team under one roof to accurately diagnose and treat all thyroid and parathyroid disorders, and our endocrine surgeons perform about 700 endocrine surgical procedures every year — many of which are challenging reoperative surgeries.
Thyroid Cancer Screening in Familial Adenomatous Polyposis (FAP) Patients
Patients with FAP have an increased risk of acquiring several tumors - most importantly colon cancer, but they are also at an increased risk of developing thyroid cancer. The Endocrinology & Metabolism Institute has a program where all patients seen in the Colorectal Surgery Department for evaluations or follow-ups related to FAP are also seen by one of the endocrine surgeons to have a thyroid ultrasound as part of their evaluation.
Thyroid Cancer Screening in Cowden Syndrome Patients
Cowden syndrome is a rare autosomal dominant condition caused by a mutation in the PTEN tumor suppressor gene which leads to the development of a number of tumors. Patients with this condition also have an increased risk of developing thyroid cancer compared with the general population. The Genomics Institute, led by Charis Eng, MD, PhD, and the Endocrine Surgery Department have embarked on a collaborative effort to provide patients with Cowden syndrome comprehensive care while at Cleveland Clinic.
Patients identified in the Genomics Institute as having Cowden syndrome are referred to Endocrine Surgery for screening thyroid ultrasounds in an effort to identify those patients with thyroid cancer as early as possible. Conversely, patients being evaluated for thyroid disease in our clinic are taken through a questionnaire designed to identify patients who might have undiagnosed Cowden syndrome, after which patients with any suspicion for this are offered a referral to the Genomics Institute for genetic screening.
Our Endocrine Surgery team is committed to providing quality outcomes, outstanding care and close collaboration with other specialists involved in the care of endocrine disorders. Our group of six full-time endocrine surgeons is one of the largest in the country, and has unique expertise in complex endocrine problems including reoperative procedures, complex thyroid cancers and endocrine malignancies.
Learn more about each of our endocrine surgeons:
Allan Siperstein, MD»
Chair, Department of Endocrine Surgery
Dr. Allan Siperstein is Chair of Cleveland Clinic’s Department of Endocrine Surgery and Program Director for the General Surgery Residency Program and Endocrine Surgery Fellowship. A graduate of the University of Texas Southwestern Medical School, he completed his general surgery residency and endocrine surgery training at the University of California. Dr. Siperstein is actively involved in research and studies in the field of endocrine surgery including molecular markers for identification of thyroid cancers, minimal incision approaches to thyroid and parathyroid surgery clinical trials, and the development of technologies for laparoscopic thermal ablation of hepatic tumors.
Eren Berber, MD»
Director, Robotic Endocrine Surgery
Dr. Eren Berber graduated from Istanbul University Istanbul Medical Faculty where he also completed a general surgery residency. He then continued his career in the U.S. by completing a general surgery residency and a laparoscopic surgery fellowship at the Cleveland Clinic and University of California San Francisco. Dr. Berber is Director of the Robotic Endocrine Surgery program at Cleveland Clinic, which performs scarless thyroidectomies and parathyroidectomies with robotic assistance.
Judy Jin, MD»
Dr. Judy Jin is an endocrine surgeon at Cleveland Clinic, and a staff physician in the Endocrinology & Metabolism Institute. She graduated from University of Cincinnati College of Medicine, completed a residency in general surgery at University Hospital in Cleveland, and went on to complete her fellowship in endocrine surgery at Cleveland Clinic. Dr. Jin’s specialty interests include surgery for adrenal disorders, pancreatic endocrine tumors, and thyroid and parathyroid cancers.
Rosemarie Metzger, MD»
Dr. Rosemarie Metzger is an endocrine surgeon at Cleveland Clinic. She attended medical school at the University of Wisconsin, completed a residency in general surgery at University of Virginia and a fellowship in endocrine surgery at Cleveland Clinic. Dr. Metzger’s specialty interests include advanced laparoscopic surgery, laparoscopic adrenalectomies, and thyroid and parathyroid surgery.
Jamie Mitchell, MD»
Dr. Jamie Mitchell is an endocrine surgeon at Cleveland Clinic. He attended medical school at the Georgetown University School of Medicine, completed a residency in general surgery at Harvard Medical School and a fellowship in endocrine surgery at Cleveland Clinic. Dr. Mitchell’s surgical treatments include advanced laparoscopic surgery, laparoscopic adrenalectomies, thyroid and parathyroid surgery, robotic surgery for adrenal, and minimally invasive endocrine surgery.
Joyce Shin, MD»
Surgical Director, Thyroid Center
Dr. Joyce Shin is an endocrine surgeon at Cleveland Clinic. Sh attended medical school at the State University of New York School of Medicine, completed a residency in general surgery at Montefiore Medical Center and a fellowship in endocrine surgery at Cleveland Clinic. Dr. Shin is the Surgical Director of Cleveland Clinic’s Thyroid Center with special interest in treatments for thyroid cancers, thyroid and parathyroid diseases and disorders, and pancreatic endocrine tumors.