OUH carries out operation in UK 'first'

A UK-first operation that removes both adrenal glands at the same time has been carried out at Oxford University Hospital NHS Foundation Trust.

The operation, a bilateral simultaneous retroperitoneoscopic adrenalectomy (BSRA), was performed by Churchill Hospital-based endocrine surgeon consultants Radu Mihai and Shad Khan in May 2019.

Such surgery to remove the adrenal glands, which are small structures attached to the top of each kidney that produce a variety of hormones, is very difficult as it requires both surgeons to be able to perform it.

Due to its complexity, only a handful of surgeons in the country can perform an adrenalectomy via the retroperitoneal approach, and with Radu and Shad we are the only Trust which has two surgeons able to do it.

BSRA is quicker and healthier for the patient and avoids the need for two separate operations or one very long procedure. While it has been performed in some European countries and in the US, it had never been done in the UK.

Performing the bilateral operation one after the other requires 3-4 hours of surgery, and is a procedure that is expected to be carried out at the Trust approximately once every two to three years.

However, by performing it at the same time, Radu and Shad were able to cause minimal tissue disruption during a more complicated but safer operation that took 90 minutes.

Shad, also an OUH Governor, said: "I was delighted to be part of a UK first operation. Oxford has always been highly regarded in terms of endocrine surgery, and I am honoured to be part of the team.

"The BSRA allows us to undertake a difficult and lengthy operation, and complete it with less trauma to the body and less post-operative pain. This allows patients to recover all the better and be discharged home sooner."

The patient involved in the UK-first BSRA operation was Angela Willcox, from Bicester in Oxfordshire, who has an advanced neuroendocrine tumour which had spread to her liver and was producing vast amounts of hormones. She required a safe and efficient operation to remove her adrenal glands which the hormones were targeting.

The operation, carried out on 10 May 2019, was successful and Angela has recovered well. She was discharged just a few days later.

She said: "Undergoing BSRA has changed my life. Before the operation I was very weak and tired. My hormone levels were very high and it made me feel dreadful. My hands were swollen and my face had become very round and puffy.

"However, following the operation I now have so much more energy. I am able to get up and around and walk around the house and garden - I have much more stamina.

"The scars have completely healed and there is no pain from the keyhole sites. My husband has been taking photos of me, and even within a few days my face was returning to normal."

After visiting a centre in Germany which first introduced the retroperitoneal approach to the adrenal, Radu has performed this operation in over 40 patients.

He said: “Patients such as Angela are rarely encountered during a medical career. Offering complex operations to patients with challenging medical conditions is less likely if the surgical team lacks the experience and confidence.

"The local expertise gained over many years worked in her favour, and we are very pleased with her smooth recovery and with her progress since discharge.

"We are welcoming patients from other counties as we aim to establish OUH as a national centre for excellence for patients with adrenal tumours."

In Angela's case, BSRA has provided palliative care, but, depending on the patient, the operation has the potential to cure Cushing's disease and adrenal metastases.

The Trust is already a leading centre in the UK for adrenal surgery, and being able to offer BSRA enhances the Trust's reputation nationally and internationally.

Pictured: Patient Angela Willcox (centre), with endocrine surgeon consultants Radu Mihai (left) and Shad Khan.