The one-year Comprehensive Endocrine Surgery Fellowship at Mayo Clinic's campus in Rochester, Minnesota, is designed to train expert endocrine surgeons through high volume and complex endocrine surgical exposure. There is an emphasis on multidisciplinary care and one-to-one mentored training which allows for a well-rounded and robust graduated autonomy experience. Fellows graduate with expertise in all aspects of surgical thyroid, parathyroid, adrenal, and pancreatic neuroendocrine disease. 

Endocrine surgery fellowship learning experiences include:

Parathyroid

•  Evaluating and treating primary, secondary, and tertiary hyperparathyroidism
• Interpreting localization studies including ultrasound, sestamibi, 4D CT, and PET Choline scans
• Re-operative parathyroid procedures
• Parathyroid autotransplantation
• Intraoperative parathyroid hormone (PTH) monitoring
• Parathyroid autofluorescence
• Evaluation and surgical approach of mediastinal parathyroid glands
• Surgical techniques for parathyroid carcinoma

Thyroid

• Benign and malignant thyroid disease
• Use of ultrasound to evaluate thyroid nodules
• Ultrasound guided fine needle aspirations (FNA)
• Surgical technique for thyroid lobectomy, isthmusectomy, and near-total or total thyroidectomy
• Central and lateral neck dissection
• Substernal goiter
• Hyperthyroidism including Graves' disease, toxic adenoma, and toxic multinodular goiter
• Metastatic thyroid carcinomas; ultrasound guided alcohol ablation
• Radiofrequency ablation (RFA) of thyroid nodules
• Pediatric thyroid surgery

Adrenal gland

• Minimally invasive laparoscopic and robotic adrenalectomy
• Posterior retroperitoneal adrenalectomy (PRA)
• Open anterior adrenalectomy
• Adrenal cortisol excess, unilateral adenoma and bilateral nodular hyperplasia
• Primary aldosteronism, interpretation of adrenal venous sampling
• Pheochromocytoma and paraganglioma
• Workup of an adrenal "Incidentaloma"
• Adrenocortical carcinoma

Pancreas

• Insulinoma
• Gastrinoma (Zollinger-Ellison syndrome)
• Nonfunctional islet cell tumors and carcinomas
• Rare hormonally active islet cell tumors

Carcinoid

• Intraoperative pharmacological management
• Resection strategies — primary tumor, lymph node metastases, distant disease
• Nonresectional therapy

Multiple endocrine neoplasia (MEN) syndromes

• MEN-1, MEN-2A and B, familial medullary thyroid cancer (FMTC)
• Von Hippel-Lindau disease (VHL), paraganglioma syndromes

In addition to extensive endocrine surgery exposure, the endocrine surgery fellow will also have dedicated experiences with expert endocrinologists, radiologists, and endocrine pathologists. Training in neck ultrasonography, ultrasound guided thyroid FNA biopsy, and ablative techniques including thyroid radiofrequency ablation (RFA) and percutaneous ethanol ablation are included.

The Endocrine surgery fellow will receive protected education time on a weekly basis to participate in faculty led teaching, fellow led journal clubs, and M&M conferences. Additionally, the endocrine surgery fellow will be mentored through a research project allowing for presentation at a regional or national surgical conference, and to complete one or more peer reviewed publications. Extensive resources within the division and the department of surgery are available to support research.

Program history

The Comprehensive Endocrine Surgery Fellowship at Mayo Clinic in Rochester, Minnesota, was established in 2006 and accepted the first fellow to the program in 2007. We anticipate that one trainee will complete this program annually.