On the 22nd of June 2024, "Adrenal Surgery: When and How" occurred in Hotel Vila Galé Coimbra, Portugal. This one-morning scientific meeting gathered some of the most experienced surgeons, endocrinologists, and urologists in adrenal surgery. It was an absolute success!
In two great lectures, Dr. Lúcia Fadiga (Endocrinology, CH Leiria) and Dr. Joana Couto (Endocrinology, IPO Coimbra) taught us everything we need to know about diagnosis and surgical indications of the adrenal nodule. Following the coffee break, Prof. Dr. Arnaldo Figueiredo (Head of Urology, CHUC) gave us an outstanding lecture on the transperitoneal approach, including single-port bilateral adrenalectomy. The posterior retroperitoneoscopic approach was addressed by myself, and my friend Prof. Dr. Ozer Makay presented his experience in robotic adrenal surgery. The scientific discussion that followed was fantastic. Some defended the posterior approach, and others transperitoneal technique, focusing on postoperative pain, indications, access to the gland, and recovery. As usual, no consensus was possible on the best technique. In the end, both have a play to role.
Ending the meeting, Prof. Dr. Martin Walz gave a remarkable lecture. He discussed several dogmas of adrenal surgery and presented data on why those dogmas should be abandoned: pre-operative alpha blockade, cancer by open surgery, no biopsy of nodules suspected of pheochromocytoma, and no ambulatory surgery.
I would like to leave you the Opening Ceremony Speech. Some doctors think they own parts of medicine, but no honest and well-prepared doctor should allow it. We must all fight those small-minded doctors. Please read the following words...
"It is a pleasure for me to have you all here. Your presence and registration were what made the organization of this meeting possible.
This is one of the first, if not the first, meetings to be organized without sponsors, no industry, and no public hospital supported this meeting. It seems that science and learning are not the main objectives of the healthcare system. But it should be. Peer discussion is what moves medicine forward. Patients benefit the most from these meetings, and all physicians should support and attend scientific meetings to stay up to date. In this scenario, healthcare providers must support science for better outcomes. Patients need well-prepared doctors who practice high-quality medicine, not numbers and Excel spreadsheets.
Adrenal Surgery: When and How will be divided into two parts.
The first part - When - will be dedicated to the diagnosis of the adrenal nodule and surgical indications. Dr. Lucia Fadiga (Endocrinologist from Centro Hospitalar de Leiria) and Dr. Joana Couto (Endocrinologist from IPO Coimbra) will teach us everything we need to know about these topics.
The second part - How - will be dedicated to minimally invasive approaches to the adrenal nodule. Prof. Dr. Arnaldo Figueiredo, Head of the Urology Department of Centro Hospitalar e Universitário de Coimbra has great experience in adrenal surgery and will talk to us about the transperitoneal approach. He is one of the best.
The posterior retroperitoneoscopic approach will be presented by myself (I hope you get something positive out of this).
Finally, my friend Prof. Ozer Makay from Izmir, Turkiye, will tell us about the robotic approach. Ozer Makay has huge experience in endocrine surgery and he is a must in these meetings. This will be a great talk.
Then the highest moment of the meeting will come. My mentor and friend Prof. Martin Walz will give a lecture on "The Best in Adrenal Surgery". Prof. Martin Walz is Head of the Surgery Department and Center of Minimally Invasive Surgery of Kliniken Essen-Mitte in Germany. Listening to Prof. Walz is always an opportunity to expand our knowledge. He is the most experienced surgeon in adrenal surgery and the "father" of the posterior retroperitoneoscopic approach. An adrenal meeting without Prof. Walz is like the Vatican without the Pope. He is a must.
Like many different topics in medicine, adrenal surgery can be handled by different doctors of different medical specialties. Having different doctors treating the same disease with different techniques within the legis artis is a good thing.
We must fight the "owners" of medicine. Those who think they own a part of medicine and surgery. Those who want to be the best by eliminating others. Those who are afraid to show their results and therefore want to be the only ones to carry out that technique and treat that particular entity. It is easy to be the best at something if you are the only one doing it. This is not good for anyone.
Sharing ideas and results is fundamental to achieving excellence in surgery. Cooperation between doctors and medical specialties in a true multidisciplinary approach where discussion takes place in a healthy environment offering the patient different approaches, is the only way to do medicine.
Although respecting the legis artis, dogmas, absolute certainties, limits, and prohibitions have no place in science and medicine. Discussion groups must be open to every single doctor. Do not limit knowledge nor create closed and restricted groups. Different eyes, different skills, and different ideas promote the best results in a melting pot where the Medicii Effect takes place.
In medicine, as in life, everything is impossible until it happens.
To all of you, thank you for being here. Enjoy!
Dr. Carlos E. Costa Almeida
Adrenal Surgery: When and Open, 22nd June 2024, opening ceremony"
At the end of the morning and after the effort I had to make to organize this meeting, I was extremely happy with the final result. It was worth the effort. To all involved, thank you for being there.
Dr. Carlos E. Costa Almeida
General Surgeon
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