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    What is it?

    The Endocrine, Metabolic and Obesity Surgery Unit of Vithas Internacional is dedicated to treatment in two areas:
    Diseases that affect the body’s endocrine glands: thyroid, parathyroid, and adrenal glands.
    Obesity and metabolic disorders that can be treated through surgery.

    The treatment of endocrine and metabolic diseases and obesity requires a group of highly-specialised professionals (endocrinologists and surgeons), such as those who make up our unit. At a surgical level, having a unit like ours that is totally focused on this area is completely necessary. It is also necessary:
    To work in multidisciplinary teams, including direct contact with an endocrinologist to agree on instructions and scope of surgery, as well as follow-ups.
    To have extensive knowledge of the medical pathology. That the endocrine surgeon has advanced knowledge about the gland disease and not just knowledge on how to operate it. This point is essential when making decisions in the operating theatre.
    Continuous updating. In our unit, technology has a very important role, especially to offer greater patient comfort, provide safety and to make procedures easier.

    Who is it for?

    In our unit we treat two different patient profiles:
    Patients with diseases of the endocrine glands: thyroid, parathyroid and adrenal glands. We deal with the treatment of thyroid cancer, as well as benign and generally asymptomatic pathologies such as multinodular goitre, or pathologies that cause excess hormonal function, such as hyperparathyroidism, which causes extremely high levels of calcium in the blood with risk of generating severe osteoporosis or kidney stones. We also treat pathologies of the adrenal gland using endoscopy.
    Patients with morbid obesity. In this case, they are patients in whom previous dietary treatments have generally failed and a more direct solution is required. The indication of surgery must be adequate and the result of teamwork with the endocrinology team. The result will be controlled weight loss, without generating nutritional deficits and increasing life expectancy and quality of life.

    Led by

    Dr Enrique Mercader, specialist in General and Digestive System Surgery and expert in endocrine, metabolic and obesity surgery leads our unit.
    He holds the European Board as a Qualified Expert in Endocrine Surgery, maximum recognition of this speciality granted by the European Union of Medical Specialist (UEMS).
    He is also a member of the board of directors of the Endocrine Surgery Section of the Spanish Association of Surgeons and is involved in the training programmes in Endocrine Surgery for residents of General and Digestive System Surgery.

    Distinctive Aspects

    In addition to the totally customised treatment and professional excellence, our unit is characterised by including all the technological improvements to make the surgery more comfortable, safer and leave less residue or scars.

    In this sense, we can highlight several techniques that differentiate us and in which we are pioneers at a national level:
    Neck surgery without cervical incision. The main consequence of traditional surgery of the endocrine glands of the neck is scarring. The scar is located in a very visible part, and if the patient has a tendency to develop hypertrophic scars, it can be very unsightly and cause discomfort. Our unit is a leader in Spain in the introduction of a technique that allows the partial or total removal of the thyroid or parathyroid glands without leaving an incision on the neck. We use video-assisted surgery techniques and make incisions in places that are hardly visible or not visible at all. From there, we access the cervical area to perform the surgery. The cosmetic result is outstanding: there is no incision mark on the neck and the gland disease is solved. To achieve a good result, proper selection of the patient is essential. In cases where this surgery is impossible, we make mini incisions in the neck which we then suture with fine threads and plastic surgery techniques so that it leaves as little scar as possible.
    Endoscopic (laparoscopic) obesity surgery. We perform all techniques by laparoscopic surgery, video-assisted surgery. This significantly reduces post-operative discomfort for the patient, while preserving the effectiveness of the procedure. The immediate consequences are less pain, a shorter hospital stay, and a faster return to daily activities.
    Monitoring of recurrent nerves. These nerves take care of the normal mobility of the vocal cords. The voice is a very important instrument of everyday life, especially in some people whose work depends on good voice quality. We currently have sensors that allow us to better detect and “care for” recurrent nerves during surgery. This results in better voice quality in the post-operative time frame.
    Specialisation. Our initial training is as general and digestive surgeons. Along our career, we have touched on many fields, from liver transplantation to colon surgery. This has given us vast experience in a variety of surgical techniques. For several years, our professional and training dedication has been focused exclusively on the field of endocrine surgery and obesity; that is all we do and that is why we are experts in this area. We deliver courses on thyroid cancer and neuromonitoring, we take part in training courses for residents in endocrine pathology and we are part of forums of experts in conferences and scientific meetings.

    What does it diagnose? What does it treat?

    • Endocrine gland surgery: Endocrine glands play an extremely important role in the body. Adequate production of hormones ensures a proper functioning. These glands can often be affected by benign processes, such as multinodular goitre or hyperparathyroidism, which can cause significant health problems for the patient. They can also be a place for cancer to settle.
      This group of pathologies is very specific. This is why extensive knowledge of the diseases is needed to offer the correct treatment. It is not only a matter of having an excellent surgical technique, but also of knowing how to work as a team, having a great deal of knowledge about the pathologies and adjusting the growing technology so that the surgery is safe and up-to-date.
    • Thyroid surgery: Benign processes affecting the thyroid: multinodular goitre, Graves – Basedow disease, thyroid nodules, recurrent thyroid cysts. Malignant processes affecting the thyroid: total extracapsular thyroidectomy with associated lymphadenectomy, where necessary.
    • Parathyroid surgery:
    • Primary hyperparathyroidism
    • Secondary hyperparathyroidism.
    • Adrenal surgery:
    • Adenoma
    • Benign unilateral tumour
    • Pheochromocytoma
    • Incidentaloma
    • Carcinoma
    • Metastasis
    • Surgery of obesity and metabolism: For patients with morbid obesity, surgery is a very important pillar, since they need a convincing solution to their problem. However, at the same time, aspects such as adequate pre-operative and post-operative preparation and long-term follow-up should not be left aside.
      To achieve a good result, working closely with the Endocrinology team and make decisions together is necessary, hence our firm commitment to the multidisciplinary approach.
      There are several surgical techniques to get the patient to lose weight.  The team of endocrinologists and surgeons must individualise each case, as each patient requires customised treatment.
      Laparoscopic surgery allows all these procedures to be performed with little discomfort for the patient and with short hospital stays (2 or 3 days).
      The current results are excellent and offer the patient a huge improvement in their quality of life after an adequate endocrinological assessment, suitable surgery and a close follow-up.
    • Bariatric surgery:
    • Tubular gastroplasty
    • Gastric bypass
    • Biliopancreatic diversion
    • Laparoscopic metabolic surgery

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