This helps to ensure proper wound healing in the postoperative period. All rights reserved. MedicineNet does not provide medical advice, diagnosis or treatment. World J Surg. This approach uses smaller incisions in the neck. A P value < 0.05 was considered as statistically significant. 2 ). Kim SK, Park I, Hur N, Lee JH, Choe JH, Kim JH, et al. The natural neck crease as an anatomic landmark for thyroid surgery Gasless single incision trans-axillary thyroidectomy: the feasibility and safety of a hypo-morbid endoscopic thyroidectomy technique. The length of the incision will vary depending on the thickness of the neck and the size of the gland or nodule, although it should be noted that virtually always the benign gland or nodule can be bigger than the incision itself, as these structures are compressible and can be manipulated through an incision smaller than the gland. A portion of the enlarged thyroid (if possible) or the entire thyroid gland may need to be removed. Rong Cong and Xinying Li contributed equally to this work. Single-port endoscopy-assisted thyroidectomy via cervical gas Please see the Expert Consult website for more discussion of this topic, including Figure 42-1. The collodion will turn white and start curling up at the edges in about 5 to 7 days. Surg Today. Surgery is typically recommended for goiters that are causing symptoms. No evidence of recurrence was found during the follow-up period. How helpful the three-dimensional endoscopy or robotic endoscopy to the completion of bilateral (total) thyroidectomy via trans-axillary approach is worth further exploration. Mitchem JB, Gillanders WE. Because the thyroid gland is situated directly in front of the trachea, or windpipe, airway obstruction may occur if blood collects in the area after surgery. A, B Step one, dissection of the route to the anterior neck area. A 5-6 cm transverse collar skin incision was made into the midline of the anterior neck 2 cm above the sternal notch. Surg Endosc. The thyroidectomy (near or total), as we know it today, began in the 1860s with the help of Billroth [ 5 ]. Endoscopic and robotic thyroidectomy for cancer. However, bleeding in the neck is potentially life-threatening because as the blood pools, it can push on the windpipe or trachea causing difficulty breathing. The exclusion criteria were as follows: (1) patients with benign nodules with diameters > 6 cm, (2) patients who needed a total thyroidectomy, and (3) patients for whom endoscopic surgery was not suitable due to past medical history of cervical and chest wall surgeries or other reasons. In general, patient should be able to eat their normal diet, but most patients prefer softer foods for the first few days. Robotic thyroid surgery using a gasless, transaxillary approach and the da Vinci S system: the operative outcomes of 338 consecutive patients. 4). The Procedure of Traditional Low Collar Incision Thyroidectomy The patient was placed in the supine position neck hyperextension. In this operation, an incision is made in the axilla (armpit) and dissection is carried superiorly across the collar bone into the neck. The rate of permanently low calcium levels after a total thyroidectomy is anywhere from 1-5%. Kang SW, Lee SC, Lee SH, Lee KY, Jeong JJ, Lee YS, et al. B A 4-cm length incision was made in the natural wrinkle of axilla and an accessory 5-mm incision was made for another operative instrument, Three standard steps method for working space make. Our results revealed the complications rate was relatively low and acceptable (Table 2). The following possible complications are directly related to the operative experience of the surgeon, and these statistics are based on our own results here at Columbia: As with any operation, there is always a chance of bleeding. Total thyroidectomy (sometimes called near-total thyroidectomy) is the surgical removal of the entire thyroid gland. In the last decade, we have performed this approach on more than 500 patients and found that patients who undergo this surgery have better cosmetic results compared with the . COVID-19 News: Vaccine Info | In Person Visits | Virtual Visits. If you are dealing with a thyroid issue, our team at the Columbia Thyroid Center is here to help. PDF Care of the Surgical Incision - American Thyroid Association a skin incision was made using scalpel, However, the risk of damage to this nerve must be understood prior to surgery. 82073262) and the Hunan Province Natural Science Foundation (grant number 2021JJ41033 and 2019JJ40475). Great efforts are made during surgery to identify and preserve this nerve on both side of the thyroid gland. With this type of anesthesia, you are completely asleep during the operation, and you will have a breathing tube placed temporarily to protect your airway and lungs. Poor cosmetic result from scarring of the neck or axillary incision may occur and require secondary scar management. This work was supported by the National Natural Science Foundation of China (grant No. In these cases, the voice will often be better in the mornings and "tire" toward the end of the day. The operation generally lasts from 2-3 hours. In about 5% of patients who have thyroid surgery, the parathyroid glands do not function properly immediately after thyroid surgery. Most people take at least 15-30 days to recover. https://doi.org/10.1186/s12957-021-02484-z, DOI: https://doi.org/10.1186/s12957-021-02484-z. Last, the strap muscles were dissected laterally, the omohyoid muscle and internal jugular vein (IJV) were also exposed. This chapter contains additional online-only content, available on expertconsult.com. 55 0 obj <>/Filter/FlateDecode/ID[<92107CDBA3A8D84ABDC22C73C8947E84>]/Index[32 48]/Info 31 0 R/Length 106/Prev 453493/Root 33 0 R/Size 80/Type/XRef/W[1 2 1]>>stream In the hands of Columbia Thyroid Center surgeons, the risk of having a temporarily low blood calcium level is about 5% and the risk of having a permanently low blood calcium level is less than 1%. After a total thyroidectomy, patients will need to take thyroid hormone replacement pills (one pill a day for the rest of their lives). Introduction: The standard approach to thyroidectomy is a collar incision via the anterior neck, and the neck scar has always been a source of worry for patients. 1). How is substernal goiter surgery performed? 2005;15:64752. Manage cookies/Do not sell my data we use in the preference centre. This procedure may also be appropriate for small, non-aggressive thyroid carcinomas less than 1cm. This approach involves making an incision in the center of your neck to directly access your thyroid gland. Thyroidectomy for Papillary Thyroid Carcinoma | SpringerLink Your incision will be located on the front of your neck. [aQ Fc8x4*hp4p,9z6iU R GEuKWT4Ci.GvIbu,sg E{miq41hJH|>&G&W Google Scholar. 1996-2023 MedicineNet, Inc. An Internet Brands company. The supraclavicular lateral collar incision is a feasible and safe approach for thyroidectomy. For patients who develop hypertrophic scars, those who develop keloids and persons who want to do everything possible to avoid an incision on the neck, this procedure is possible. The primary advantage of this surgical procedure is avoidance of an incision on the neck. The dissected area is marked in red. The addition of robotics can improve surgical dexterity in a difficult-to-reach anatomic region [6]. Although the risk of these complications cannot be eliminated entirely, they can be minimized in the hands of an experienced thyroid surgeon. It is rare for them to appear after 72 hours. Statistical analyses were conducted using the Students t test and one-way ANOVA through the SPSS 23.0 software. The surgical procedure was similar to the methods described by other surgeon groups [11, 12]. The patients were either satisfied or very satisfied with the cosmetic effects. Incisions as small as 1 inch (2.5 cm) can be performed for patients with favorable neck anatomy and small tumors. The contribution of the incision to the cosmetic outcome does not end with the making of the incision itself. As the scar heals, it will appear to be part of the crease and thus camouflage it. Incision: A transverse collar incision is usually made 1-2 fingerbreaths above the sternum along the skin crease. This approach accesses the thyroid through an incision inside the mouth. Comparison between 3-dimensional and 2-dimensional endoscopic thyroidectomy for benign and malignant lesions: a meta-analysis. Kim EY, Lee KH, Park YL, Park CH, Lee CR, Jeong JJ, et al. In our study, only two cases had temporary vocal cord paralysis. Department of General Surgery, Xiangya Hospital, Central South University, No. volume20, Articlenumber:9 (2022) Surg Endosc. A number of important principles are worth considering when planning a thyroidectomy or parathyroidectomy, and these transcend the specific procedure that is anticipated. When present, surgical removal is generally indicated. The patient may then be placed on thyroid hormone pills. With careful preoperative testing and thoughtful consideration of the type of anesthesia, including the type of intubation, preparation for surgery can be optimized. Thyroidectomy Basics | Epomedicine In the absence of contraindications, substernal goiter should be treated with early surgery rather than having it run the risk of acute airway distress, especially in younger patients. First, we dissected the tunnel to the anterior neck area with exposure of the sternocleidomastoid muscle (SCM). A 5- to 7-cm arc incision was made along the dermatoglyphic direction, 1-2 cm above the sternal notch. After showering, pat the incision dry. 2021;35(7):3540-3546. https://doi.org/10.1007/s00464-020-07814-y. In the past, piecemeal or berry picking operations have been advocated, but currently, removal of all lymph nodes in all levels or compartments containing metastatic nodes is performed. Muenscher A, Dalchow C, Kutta H, Knecht R. The endoscopic approach to the neck: a review of the literature, and overview of the various techniques. As the radical operations of the 1960s and 1970s gave way to the more selective operations of the 1980s and 1990s, neck incisions for thyroid and neck dissection evolved. For persons with pre-existing shoulder abnormalities, these could be exacerbated by surgery. Surg Oncol Clin N Am. After surgery, the patient will stay in the recovery room for several hours. 32 0 obj <> endobj Classically, standard thyroid lobectomy or thyroidectomy has been performed through an incision low in the neck called the low collar incision. A concept that has gained traction in recent years is the customization of both the incision and the surgery to the patient and the disease characteristics, rather than a one size fits all approach.9 Historically, surgeons proposing to accomplish a thyroidectomy would make a standard length incision in a routine location and accomplish an identical operation for each patient. Cir Esp (Engl Ed). The best suits have snaps in the areas of the penis or vulva and the anus so you don't have to take the suit off when . During the post operative visit, a blood test called TSH level may be checked to measure the levels of thyroid hormone in order to determine if the dose is correct. Figure 42-3 This young woman who has an 11-inch neck (A) and a solitary 2-cm nodule (B), which cytologically is consistent with a follicular neoplasm, is an excellent candidate for a minimal invasive or remote access procedure. wnya@Q7-$Omag[>JI[Kf;-TpOZ0v{ }b/n:WwWi4(^{=]~(O l4!|lgp$uWx)>lvK@#\K!i' y~F-yv~`=0%->s:K,z3/=K[po>@nrLo j, See additional information. Compared to two-dimensional endoscopic thyroidectomy, three-dimensional endoscopic thyroidectomy is an efficient, safe, and reliable method with better depth perception and stereoscopic vision, and an equally satisfactory outcome [23]. This surgical procedure is known as athyroidectomy. Furthermore, the sensory change and paralysis results from this technique and patients satisfaction with the cosmesis were also studied. Once at home, patients and their friends/family should watch for signs such as difficulty breathing, a high squeaky voice, swelling in the neck that continues to get bigger, and a feeling that something bad is happening. Thyroid hormone levels will then be measured about every 2 months until the hormone levels are stable (levels generally stabilize in 4 to 5 months). Single-incision, gasless, endoscopic trans-axillary total thyroidectomy: a feasible and oncologic safe surgery in patients with papillary thyroid carcinoma. It is not common to need these additional tests, but they may include: Fiberoptic laryngoscopy: This test allows the surgeon to look at how well the vocal cords are moving by passing a thin flexible camera through the nose into the airway. Patients who are asked to stay overnight generally have very large goiters, advanced cancer, bleeding disorders, a history of taking anticoagulation, or have a personal preference to spend the night. Rarely, nerve injury to the arm can occur, resulting in impaired arm and/or hand function. Routine level 2b dissection may be recommended only in N1b papillary thyroid carcinoma with three- or four-level lateral lymph node metastasis. The risk of a substernal goiter is higher in people who: 1996-2023 MedicineNet, Inc. An Internet Brands company. Lang BH, Chow MP. By contrast, a television commentator with an 11-inch neck (Figure 42-3, A) and a 2-cm follicular neoplasm (Figure 42-3, B) is an ideal candidate for an endoscopic thyroidectomy. Later on, in 1880, Jules Boeckel of Strasbourg introduced the collar incision to thyroid surgery, and this approach was popularized, later on, by Theodor Kocher. Minimally invasive thyroid surgery refers to certain types of surgery in which the thyroid is removed through very small incisions using special techniques. Specific procedural considerations are described, and then a concise enumeration of proposed best practices is offered. https://emedicine.medscape.com/article/2051665-overview. Patients with other significant medical issues may be asked to visit with their medical team to obtain a letter of medical clearance. However, the rate of complications is higher in individuals older than 60 years of age. 2017;274:495500. The sternal head of the SCM was subsequently retracted to expose the strap muscles. This study was approved by the Institutional Ethics Committee of Xiangya Hospital, Central South University (No.202011960). Classically 8-12 cm (3-5 inch) incisions were performed. Meanwhile, prospective clinical studies are needed to investigate and validate surgical and oncological outcomes. Injury of internal jugular vein (IJV) in two cases. TR}Iu9!'\2q/ Next, an endoscope with two cameras that produce three-dimensional viewing is inserted into the incision, and three robotic arms are inserted into the incision. Indications for this procedure include unilateral goiter and unilateral benign thyroid nodules. Another variation of the minimally invasive thyroidectomy is the minimally invasive video-assisted thyroid surgery (MIVAT). This can also happen after parathyroid surgery. A popular alternative to cones is a post-op surgical/recovery suit. CAT scan of the chest: This test allows the surgeon to evaluate if the thyroid disease is growing down into the chest and if so, how it is affecting the structures in the chest. A number of technological advances such as advanced energy devices for hemostasis,1 high-resolution endoscopes for improved visualization,2 and laryngeal nerve monitoring3 have increased the focus on cosmetic outcomes and the pursuit of smaller, well-camouflaged incisions.4 Also emerging are techniques for remote access thyroid and parathyroid surgery.5,6 Conventional surgery remains necessary in many circumstances, such as for large substernal goiters or advanced malignancy, and will remain in the endocrine surgeons armamentarium. Yan HC, Xiang C, Wang Y, Wang P. Scarless endoscopic thyroidectomy (SET) lateral neck dissection for papillary thyroid carcinoma through breast approach: 10 years of experience. This procedure ensures patients cosmetic needs by making incisions under the axilla, which allows for the removal of nodules, even large nodules [7]. Excellent long-term cosmetic outcomes can be expected with minimally invasive endoscopic thyroid surgery (B). After the seventh day, reduce the calcium to one Tums Ultra 1000 tablet three times a day until your follow-up appointment. In general, there are three types of thyroid resections: A total thyroidectomy may be done for a variety of diseases including thyroid cancer, Graves' disease (See Hyperthyroidism ), multinodular goiter, and substernal goiter, among others. 79 0 obj <>stream The majority of people will likely be candidates for this procedure. hbbd``b`$M .$A "H$&X@2`b AzU R\bitiL #3=|` h Temporarily lowered calcium levels occur in approximately 15-40% of patients, and is treatable with calcium and vitamin D supplementation post-operatively. Thyroidectomy for substernal usually includes goiters with minimal extension in the thoracic cavity and those that are present in the mediastinum (the area surrounding the chest cavity). Terms of Use. Thyroid Surgery Recovery, Side Effects, and Complications - Verywell Health The total mean operative time of working space make was 44 12.8 min (range 20120 min). Medscape. They have a higher death rate due to postoperative complications. No evidence of recurrence was found during the follow-up period. The exceptions are blood thinners, aspirin, Plavix, and anti-thyroid medications like PTU and Methimazole. See our Scar Gallery section for examples of minimally invasive thyroid surgery. However, depending on the presence of any visible skin crease, a higher incision at the cricoid level along the visible skin crease is sometimes preferred to enhance the cosmetic outcome (Fig. This test is used in patients with hoarseness, a previous neck operation, or cases of advanced cancer. Surg Endosc. The typical recommendations for pre-operative testing include: In addition, patients may require additional tests in certain situations to help plan the operation. The CAT scan will also allow the surgeon to see if the trachea is being moved to one side or the other and if it is being narrowed by the thyroid. Patients should call their surgeon's office to make a follow up appointment 3 weeks after surgery. These symptoms appear between 24 and 48 hours after surgery. It is noteworthy that there is another obvious disadvantage of this technique. AN INCISION (CUT) THAT WILL REQUIRE SPECIAL CARE. Solved Preop Dx: Cold thyroid nodule Postop Dx: Multinodular - Chegg UC Irvine was the first institution on the West Coast of the United States to perform this operation. With the transformation of thyroid and parathyroid surgery since the late 1990s, there are now a variety of methods for accessing the thyroid and central neck. Surg Endosc. Aside from fine needle or core needle aspiration of the thyroid gland, the minimal operation for management of the thyroid is hemithyroidectomy, or thyroid lobectomy. Jantharapattana K, Maethasith J. Transaxillary gasless endoscopic thyroidectomy versus conventional open thyroidectomy: a randomized study. Most patients may need to take thyroid hormone pills (thyroid hormone replacement) for the rest of their lives when the whole thyroid gland is removed. A number of technological advances such as advanced energy devices for hemostasis, 1 high-resolution endoscopes for improved visualization, 2 and laryngeal nerve monitoring 3 have increased the focus on cosmetic outcomes and the pursuit of smaller, well-camouflaged incisions. Prior to the operation, patients will need certain pre-operative testing to make sure that they are healthy enough and properly prepared for an operation. Classically 8-12 cm (3-5 inch) incisions were performed. Surgery is the most commonly used technique in treating thyroid diseases. C and D, Both the right and the left neck may be thoroughly dissected with appropriate retraction assistance. Patients should discuss with their doctors when and if they should restart these medications. Ann Surg Oncol. that the dissected flap width in trans-axillary approach is significantly wider than conventional thyroidectomy, causing greater trauma, and potentially more severe pain [20]. We have been using this approach since 1999. There are a number of factors that affect suitability for this procedure. After the seventh day, reduce the calcium to one Tums Ultra 1000 tablet three times a day until your follow-up appointment. 2020;34:1891903. Berber E, Bernet V, Fahey TJ 3rd, Kebebew E, Shaha A, Stack BC Jr, et al. qDH z(a;Lq#t Closure of skin incision after thyroidectomy through a supraclavicular In the past decade, efforts were made to reduce incision size and surgical access trauma by the use of endoscopic techniques. J Minim Access Surg. Parathyroidectomy ZYZ modified the design of the study. Kocher himself, however, recognized the logic behind utilizing as small an incision as possible and is quoted as saying thyroidectomy incisions should be as small as possible, as big as necessary, therefore perhaps qualifying him as the first minimally invasive surgeon. Thyroidectomy is the main surgical treatment for thyroid cancer and is a treatment option for certain thyroid conditions, including: Gasless, endoscopic trans-axillary thyroid surgery is a feasible procedure with acceptable safety and better cosmetic results in strictly selected patients. Patients may also be given a prescription for thyroid hormone medication (Levothyroxine or Synthroid).
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