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. In addition to the complications of standard thyroid surgeries listed below, there are several complications specific to this operation. Indications for removal of the gland include most types of thyroid cancer, large goiters causing compression of the airway, and Graves disease. World Journal of Surgical Oncology Thyroid cancer can also spread to the lateral neck. In our study, only two cases had temporary vocal cord paralysis. Popular incisions included the Lahey incision (Figure 42-1. 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. All rights reserved. The size of the incision is dictated by surgeon preference and need for adequate exposure to remove the tumor. World J Surg Onc 20, 9 (2022). Although the risk of these complications cannot be eliminated entirely, they can be minimized in the hands of an experienced thyroid surgeon. Only two patients developed temporary vocal cord paralysis and no patient developed permanent vocal cord paralysis. Figure 42-6 The optimal position in which to mark the anticipated thyroid incision is with the patient seated upright in the holding area. For example, a gentleman with a 26-inch neck (Figure 42-2, A) and a large goiter (Figure 42-2, B) is not a good candidate for any type of minimally invasive approach. This nonobese gentleman who has a 26-inch neck circumference and a large goiter would not be a candidate for any minimally invasive approach. 2017;27:115864. 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. In the UK, thyroidectomy is not routinely performed under regional anaesthesia. 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. The dissected area is marked in blue, The procedure of thyroidectomy and central neck dissection (CND). This approach uses smaller incisions in the neck. Only two patients developed temporary vocal cord paralysis and no patients developed other severe complications. 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. They will be monitored closely as they need to recover from the anesthesia. The midline fascia was divided and strap muscles separated from the thyroid gland. An accessory 5-mm incision was made on the vertical line of the axillary incision (35 cm far away from this incision) for another operating instrument (Fig. See additional information. In addition to classifying the extent of surgical resection, a number of surgical approaches have been described. Provided by the Springer Nature SharedIt content-sharing initiative. A portion of the enlarged thyroid (if possible) or the entire thyroid gland may need to be removed. Surg Endosc. Clinical findings and postoperative complications were analyzed. After surgery, the patient will stay in the recovery room for several hours. Typically, patients will be given prescriptions for the following medications after the operation: Calcium: Symptoms of hypocalcemia can generally be prevented by taking two Tums Ultra 1000 tablets three times a day for seven days after surgery along with 2000 IU Vitamin D3 daily. Indications for this procedure include unilateral goiter and unilateral benign thyroid nodules. Compared with conventional open surgery, gasless endoscopic trans-axillary thyroid surgery requires the dissection of the anterior neck area and splitting the SCM, which has been described in the endoscopic lateral neck dissection [15]; however, the stiffness and paraesthesia of the SCM have not been evaluated. Some people experience a dull ache, while others feel a sharp pain. The mean age was 34 years old, ranging from 19 to 45 years. This work was supported by the National Natural Science Foundation of China (grant No. There are a number of factors that affect suitability for this procedure. Patients diagnosed with thyroid cancer and thyroid nodules with diameters > 4 cm who underwent trans-axillary thyroid surgery from July 2020 to March 2021 in Xiangya Hospital were retrospectively enrolled. Although conventional thyroidectomy has successful surgical outcomes, robotic minimally invasive procedures, known for their scar free (regarding the neck, no collar incision) surgical outcomes gained popularity through the years. Endoscopic minimally invasive thyroidectomy: first clinical - Springer In the hands of our Columbia Thyroid Center surgeons, the chance of having a temporary hoarseness is 3% and the chance of having a permanent hoarseness is less than 1%. 202011960). Lee DY, Oh DJ, Kang KR, Kim MS, Oh KH, Baek SK, et al. It is important to note that numbness and tingling may be caused by something other than a parathyroid problem. 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. Bilateral axillary approach for total thyroidectomy ensures better identification of recurrent laryngeal nerve (RLN) and PTG on both sides. The location of the tumor was right, n= 30; left, n= 21. The procedure for thyroidectomy and CND was similar to that of other endoscopic and open approaches. This test is used in patients with hoarseness, a previous neck operation, or cases of advanced cancer. Goiters may be a result of the over or underproduction of the thyroid hormone or the presence of nodules in the thyroid gland. For standard-length incisions, a good alternate choice, if a normal symmetrical crease is not available, is a line parallel to a normal skin crease. The best way to identify the proper crease and overall location is with the patient sitting upright in the preoperative holding area rather than waiting until the patient is lying supine on an operating table (Figure 42-6). Both lobes of the thyroid were noted to be enlarged. Last, the strap muscles were dissected laterally, the omohyoid muscle and internal jugular vein (IJV) were also exposed. Chen GZ, Zhang X, Shi WL, Zhuang ZR, Chen X, Han H. Systematic comparison of cervical and extra-cervical surgical approaches for endoscopic thyroidectomy. Figure 42-2 This nonobese gentleman who has a 26-inch neck circumference and a large goiter would not be a candidate for any minimally invasive approach. It is nearly always preferable to identify and utilize a preexisting skin crease (if present), as this will result in the most optimally camouflaged scar. Patients will receive general anesthesia. 2021;35(7):3540-3546. https://doi.org/10.1007/s00464-020-07814-y. Most patients will feel like they have a sore throat for the first few days after the operation, especially when swallowing. Objective: To verify the effectiveness and cosmetic results of thyroidectomy through a lateral supraclavicular incision. A special retractor is placed to create a space for the surgeon to remove the thyroid gland. hb`````Jg`a`6Tcg@ ~+s\``fy$ S@5@YN@ZA:V^`` HWy6rC+1oxD7`v`Xvz&fq=@&2` &{^j@ 8S With careful preoperative testing and thoughtful consideration of the type of anesthesia, including the type of intubation, preparation for surgery can be optimized. Retractor was placed beneath the strap muscles to finish creating the working space (Fig. The surgeon has excellent magnified visualization, can manipulate the camera to customize the view of the field, and works with surgical instruments that are more maneuverable than the human wrist and hand. It has been pointed out by Kang et al. A comparison of postoperative pain after conventional open thyroidectomy and single-incision, gasless, endoscopic transaxillary thyroidectomy: a single institute prospective study. Our data indicated that sensory changes around the anterior chest are relieved over time in most cases. The two other complications that may occur after thyroid surgery involve two of the structures that are intimately associated with the thyroid gland and that may be affected by surgery, the parathyroid glands and the recurrent laryngeal nerve. endstream endobj startxref Cong, R., Li, X., Ouyang, H. et al. 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 . If the recurrent laryngeal nerve is damaged, patients may have vocal cord weakness or paralysis, causing either hoarseness or a weak, breathy voice, and in severe cases of bilateral paralysis, respiratory distress. Medical records were reviewed retrospectively. 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. 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 make every effort to eliminate the use of 4 4 gauze sponges during the operation, as the material is abrasive and behaves like sandpaper when it is placed into and retrieved from small incisions. Endoscopic and robotic thyroidectomy for cancer. Standard incisions that are placed too low, spanning this indented suprasternal notch region, may appear asymmetrical and tend to be hypertrophic in their midsegment as opposed to incisions higher, in a more uniform, cylindrical region of the neck. 2017;24:R1326. As the scar heals, it will appear to be part of the crease and thus camouflage it. This suggests that discomfort in the anterior neck area and SCM is obvious shortly after surgery and is relieved over time in most cases. Thyroid cancer is an increasingly prevalent malignancy worldwide [].Surgery is the most commonly used technique in treating thyroid diseases. In addition, the scar may become pink and hard. In general, patient should be able to eat their normal diet, but most patients prefer softer foods for the first few days. The muscles around the thyroid gland are retracted to expose the thyroid gland. When a large thyroid lobe is delivered through small incisions, it is not uncommon to observe evidence of an ischemic or traumatized skin edge, Technological Innovations in Thyroid and Parathyroid Surgery, Approach to the Mediastinum: Transcervical, Transsternal, and Video-Assisted, Non-Neural Complications of Thyroid and Parathyroid Surgery, Surgery for Locally Advanced Thyroid Cancer: Larynx, Principles in Surgical Management of Primary Hyperparathyroidism, Surgery of the Thyroid and Parathyroid Glands Expert Consult Pre. Temporary nerve damage occurs in 6-8% of cases. 14,17,18 Indications for OMIT are defined as thyroid volume >30ml but <70-80ml and a dominant nodule . Approximately 70% of patients who have half of a normal thyroid gland left in place will not require thyroid hormone replacement pills. The collodion will turn white and start curling up at the edges in about 5 to 7 days. Comparison of learning curves for retroauricular and transaxillary endoscopic hemithyroidectomy. Continuous variables are presented as the mean SD and the mean (range). 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. The vast majority of patients do not require narcotic pain medications. Preoperative fine-needle aspiration cytology (FNAC) suggested malignancy in 42 patients, where lobectomy and prophylactic unilateral central neck dissection were performed. In the first 20 cases, the longest time of working space makes was more than 2 h. However, it is likely that the operative time, including working space makes and thyroidectomy with or without CND, will gradually decrease as we gain more experience. Surgery is typically recommended for goiters that are causing symptoms. This procedure ensures patients cosmetic needs by making incisions under the axilla, which allows for the removal of nodules, even large nodules [7]. However, despite careful technique, it is not uncommon to observe skin edges at the end of a procedure (particularly minimally invasive surgery) that are ischemic and traumatized. 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. 4 Also emerging are techniques for remote access thyroid and It is usually removed in 1-2 days. Cir Esp (Engl Ed). Comparison of total endoscopic thyroidectomy with conventional open thyroidectomy for treatment of papillary thyroid cancer: a systematic review and meta-analysis. A The superior thyroid vessels were individually ligated. The surgical procedure was similar to the methods described by other surgeon groups [11, 12]. Terms and Conditions, Second, we divided the area between the sternal and clavicular head of the SCM, up to the annular cartilage and down to the clavicle. We also recommend a multivitamin for most patients. 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. For images of a functional neck dissection, see following images. Most people take at least 15-30 days to recover. Koh YW, Park JH, Kim JW, Lee SW, Choi EC. Another variation of the minimally invasive thyroidectomy is the minimally invasive video-assisted thyroid surgery (MIVAT). Because much of the earlier thyroid surgery was done for malignancy, descriptions emerged regarding the appropriate way to accomplish a thyroidectomy combined with a neck dissection. Transaxillary robotic thyroid lobectomy and transaxillary robotic thyroidectomy were developed in Korea, and over the last several years has been utilized by a small but growing number of surgeons. MIVAT combines the small incision with use of endoscopes to help provide illumination and visualization of the tumor. The parathyroid glands control calcium homeostasis within the body. This procedure may also be appropriate for small, non-aggressive thyroid carcinomas less than 1cm. Thyroidectomy Guide: Causes, Symptoms and Treatment Options - Drugs.com MedicineNet does not provide medical advice, diagnosis or treatment. Privacy Total thyroidectomy (sometimes called near-total thyroidectomy) is the surgical removal of the entire thyroid gland. In conclusion, these results revealed that gasless, endoscopic trans-axillary thyroidectomy is a feasible surgery type with an acceptable safety profile and cosmetic outcomes in strictly selected patients. Columbia Thyroid Center surgeons perform minimally invasive thyroid surgery in over 95% of patients, typically using an incision measuring just an inch to an inch and a half in length. The patient is usually given general anesthesia to numb the. PubMed Central Thyroid. Duncan TD, Ejeh IA, Speights F, Rashid QN, Ideis M. Endoscopic transaxillary near total thyroidectomy. 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. Because much of the earlier thyroid surgery was done for malignancy, descriptions emerged regarding the appropriate way to accomplish a thyroidectomy combined with a neck dissection. Wound infections happen in about 1 out of 2000 operations (far less than 1%) and because of this low risk, the routine use of antibiotics is not needed. If the mass is deep inside the chest, the surgeon makes an incision along the middle of the chest bone. Feeling that something is stuck in the throat. The risk of having any of these complications depends on the experience of the surgeon. 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 Kang JB, Kim EY, Park YL, Park CH, Yun JS. The first lymph nodes to be involved are generally the paratracheal lymph nodes. endstream endobj 33 0 obj <>>> endobj 34 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text/ImageC]/XObject<>>>/Rotate 0/Thumb 11 0 R/TrimBox[0.0 0.0 612.0 792.0]/Type/Page>> endobj 35 0 obj <>stream Eur Arch Otorhinolaryngol. Meanwhile, prospective clinical studies are needed to investigate and validate surgical and oncological outcomes. It provides satisfactory cosmetic outcomes compared with conventional transcervical incision. Minimally invasive thyroid surgery refers to certain types of surgery in which the thyroid is removed through very small incisions using special techniques. Due to this rare risk of bleeding, patients are observed for 4 hours by our highly trained recovery room staff. Our study suggested that the lateral supraclavicular incision is a safe and practical approach for thyroidectomy. Jsls. Gasless single incision trans-axillary thyroidectomy: the feasibility and safety of a hypo-morbid endoscopic thyroidectomy technique. A comparison of surgical outcomes between endoscopic and robotically assisted thyroidectomy: the authors' initial experience. The internal jugular vein was injured in two of the patients during the making of working space, one patients operation was converted to open surgery. E, F Step three, the strap muscles were dissected laterally and the retractor was placed beneath the straps muscle to expose the thyroid lobe. The Advantages of Robotic Over Open Thyroidectomy in Thyroid - PubMed 2 ). B In this case, the hemorrhage of IJV has been controlled by using Harmlock. Some patients experience a "crawling" sensation in the skin, muscle cramps or headaches. What percentage of the human body is water? Great efforts are made during surgery to identify and preserve this nerve on both side of the thyroid gland. Other risks of thyroid surgery include wound infections and seromas. After a total thyroidectomy, patients will need to take thyroid hormone replacement pills (one pill a day for the rest of their lives). Jantharapattana K, Maethasith J. Transaxillary gasless endoscopic thyroidectomy versus conventional open thyroidectomy: a randomized study. The supraclavicular lateral collar incision is a feasible and safe approach for thyroidectomy. Thyroidectomy: Overview, Preparation, Technique - Medscape However, in the first 24 to 48 hours, patients and their family/friends should observe the incision and neck for signs of bleeding in the neck 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. Based on this procedure, Kang et al. All authors have no conflicts of interest or financial ties to disclose. Fifty-one patients (42 PTC patients and 9 thyroid adenoma patients) were included in this study. Permanent nerve damage occurs in approximately 1% of cases performed by a skilled surgeon. Several reports with large case cohorts were regarding robotically assisted thyroidectomy [8,9,10]. The time of LT with or without CND was 40.9 15.1 min (range 3090 min). A 5-6 cm transverse collar skin incision was made into the midline of the anterior neck 2 cm above the sternal notch. PDF Creative Commons License [CC BY-NC-ND 4.0] 2022 The Author(s Excellent long-term cosmetic outcomes can be expected with minimally invasive endoscopic thyroid surgery (B). The average blood loss for this operation is less than a tablespoon and the chance of needing a blood transfusion is extremely rare. However, patients will be asked to do no heavy lifting, swimming, or soaking in a bathtub for 1 week after the operation. Background Since Theodor Kocher reduced the mortality rate of thyroidectomy from the 40% reported by Billroth to 0.2% in 1895, a collar incision with open removal of the thyroid gland is the standard procedure [1, 2]. Clinical findings and postoperative complications of patients who had undergone trans-axillary thyroid surgery due to thyroid cancer and thyroid nodules were retrospectively studied. If the seroma is large, the surgeon may drain it with a small needle. The addition of robotics can improve surgical dexterity in a difficult-to-reach anatomic region [6]. It seems no consensus has been reached on the clinical application of this technique considering the discrepant complications rate. The traditional "Kocher incision", an 8-10 cm collar incision, is regarded as the conventional appropriate incision for thyroidectomy.2 However, many new approaches for thyroid surgery were developed in order to further minimize the size of the surgical incision.3 Post-thyroidectomy scars have a negative effect on quality of life. 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. Piccoli et al. The contribution of the incision to the cosmetic outcome does not end with the making of the incision itself. Kang SW, Lee SC, Lee SH, Lee KY, Jeong JJ, Lee YS, et al. WHERE WILL THE INCISION BE? B, With wide elevation of subplatysmal flaps, all levels of the neck are accessible. This approach involves making an incision in the center of your neck to directly access your thyroid gland. . In the past decade, advancements in A c c e p t e d . Temporary hoarseness usually gets better within a few weeks, but can take up to 6 months to resolve. 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). They have a higher death rate due to postoperative complications. These symptoms appear between 24 and 48 hours after surgery. The PSSs were 1 (very satisfied), 2 (satisfied), 3 (unsatisfied), or 4 (very unsatisfied) [13].
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