Endoscopic versus conventional thyroid surgery: a comparison of quality of life, cosmetic outcomes and overall patient satisfaction with treatment. 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. The mean size of the benign tumors was 39 mm (range 3149 mm), and the mean size of malignant tumors was 10,0 mm (range 526 mm) (Table 1). 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. While the majority of patients accept a thyroidectomy scar, a certain percentage of patients are not satisfied with a visible scar on the neck. MedicineNet does not provide medical advice, diagnosis or treatment. 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. This can also happen after parathyroid surgery. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. Gasless, endoscopic trans-axillary thyroid surgery is a feasible procedure with acceptable safety and better cosmetic results in strictly selected patients. This hardening will peak at about 3 weeks and may result in some tightness especially when swallowing or extending your neck. Kendall Jenner and her new love Bad Bunny were both seen arriving at the Mark Hotel in New York City on Monday ahead of their anticipated arrival at the Met Gala later in the evening. What percentage of the human body is water? The trans-axillary approach (TA) can hardly locate the contralateral thyroid lobe, causing the limitation of TA in bilateral thyroidectomy. This surgical procedure is known as athyroidectomy. Hypocalcemia can cause symptoms such as numbness and tingling (especially around the lips and in the hands and feet) as well as cramping and even "locking" of the hands and feet. 2016;26:3317. The patient may then be placed on thyroid hormone pills. 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. 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. This suggests that discomfort in the anterior neck area and SCM is obvious shortly after surgery and is relieved over time in most cases. These nerve control the vocal cords. 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. 1). 32 0 obj <> endobj However, the da Vinci system is blamed for a prolonged surgery duration and a significantly higher economic cost. 2009;146:104855. Mechanical retractors and incision selection. This consists of removal of one lobe of the thyroid gland, and the isthmus of the gland. 14,17,18 Indications for OMIT are defined as thyroid volume >30ml but <70-80ml and a dominant nodule . This study was approved by the Institutional Ethics Committee of Xiangya Hospital, Central South University (No.202011960). All data generated or analyzed during this study are included in this published article. %PDF-1.6 % J Minim Access Surg. Surg Endosc. 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. A P value < 0.05 was considered as statistically significant. 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. World J Surg Oncol. Because there is no more gland to produce thyroid hormone after a total thyroidectomy, patients are dependent on long-term thyroid hormone supplementation after surgery. The opposite lobe is not removed, and in general the remaining thyroid gland will produce enough thyroid hormone for the body. Patients will receive general anesthesia. Even in the rare chance of having a permanently hoarse voice, there are things that can be done to improve or fix the voice. See additional information. Manage cookies/Do not sell my data we use in the preference centre. Mitchem JB, Gillanders WE. Most people will not be able to notice the incision once the redness fades away. The safety of gasless endoscopic trans-axillary thyroid surgery is still undetermined. Our results revealed the complications rate was relatively low and acceptable (Table 2). COT allows good direct exposure for both thyroid lobes and central neck compartment. Opening of the chest in the surgical management of substernal goiter is rarely required. As the working space is crucial to the surgery and time-consuming, the time of working space makes and thyroidectomy were calculated separately. 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. Collar incision was made about 2 1/2cm above the inner ends of the clavicle, through the platysmal muscle. Duncan et al. In addition to the complications of standard thyroid surgeries listed below, there are several complications specific to this operation. This procedure may also be appropriate for small, non-aggressive thyroid carcinomas less than 1cm. Only gold members can continue reading. a skin incision was made using scalpel, A The superior thyroid vessels were individually ligated. After a total thyroidectomy, patients will need to take thyroid hormone replacement pills (one pill a day for the rest of their lives). Incomplete removal of the thyroid and complications in preserving all the critical structures beneath and around the thyroid gland are frequent events among inexperienced and occasional thyroid surgeons. 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. Based on this procedure, Kang et al. qDH z(a;Lq#t If a patient has symptoms caused by low blood calcium, the surgeon may prescribe extra calcium and a vitamin D supplement. 2013;22:113. This study kept the confidentiality of patient data and strictly complied with the Declaration of Helsinki and its later amendments or comparable ethical standards. This will disappear over the next 3 to 6 months. Expert thyroid care for adults and children. The neck was entered through a collar incision, and bleeding was controlled with electrocautery. There is no clear definition of what minimally invasive means, and surgical incisions as large as 6 cm. ZYZ modified the design of the study. The final pathology is ready approximately1 week after the operation. The exceptions are blood thinners, aspirin, Plavix, and anti-thyroid medications like PTU and Methimazole. A, B Step one, dissection of the route to the anterior neck area. A first attempt was replacement of the central . Surg Endosc. In the hands of an experienced thyroid surgeon, thyroid surgery is a safe procedure with few complications. low collar incision Because of the risk of hypertrophic scarring, we recommend resecting a sliver of skin edge whenever and wherever this is recognized (Figure 42-7). Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. This approach accesses the thyroid through an incision inside the mouth. However, COT normally requires a long collar incision (usually 5-8 cm in length) on the anterior neck [1]. A comparison of postoperative pain after conventional open thyroidectomy and single-incision, gasless, endoscopic transaxillary thyroidectomy: a single institute prospective study. For persons with pre-existing shoulder abnormalities, these could be exacerbated by surgery. A 4-cm length incision was made just behind the anterior axillary fold for the laparoscope (a rigid 30-degree videoscope) and one operating instrument. This chapter contains additional online-only content, available on expertconsult.com. The typical incision made for thyroid surgery is known as a "collar incision" in which a large incision (around 5 to 6 inches) is made stretching from one side of the neck to the other just above the collar bone. A tube may be left in place to drain fluid and blood. Thyroidectomy incisions have significantly decreased in size since Kocher first popularized his low collar incision in the late 19 th century 4. Kang SW, Lee SC, Lee SH, Lee KY, Jeong JJ, Lee YS, et al. AN INCISION (CUT) THAT WILL REQUIRE SPECIAL CARE. volume20, Articlenumber:9 (2022) B, C The recurrent laryngeal nerve (RLN) was identified and then traced. The hockey-stick incision (C) avoids trifurcations and provides plentiful exposure for a comprehensive neck dissection. The retractors (Kangji, Hangzhou, China) were used to maintain the working space during the operation. VRSs were relatively high at the 1-week and 1-month visits and were significantly decreased at the 3rd-month visit. 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. Skin flaps were created deep to the platysma up to the hyoid bone and down to the suprastemal notch. As the scar heals, it will appear to be part of the crease and thus camouflage it. Surgery is typically recommended for goiters that are causing symptoms. Google Scholar. 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. The nodes may be referred to as level 6 lymph nodes based on the AJCC staging criteria. Specific procedural considerations are described, and then a concise enumeration of proposed best practices is offered. The cosmetic effect and the self-healing of the discomfort in the anterior neck area and SCM suggest that the application of gasless endoscopic trans-axillary thyroidectomy is feasible. It is important to minimize the amount of trauma to the skin edge, either from retraction or from inadvertent instrument trauma (for example, electrocautery and ultrasonic energy burns or gauze abrasion). All cases of this complication reported to date have been temporarily, and is related to compression of the brachial plexus from arm positioning during surgery. Total thyroidectomy (sometimes called near-total thyroidectomy) is the surgical removal of the entire thyroid gland. Gasless, endoscopic trans-axillary thyroid surgery: our series of the first 51 human cases. A, An extended low cervical collar incision is used when a lateral neck dissection is indicated. Bilateral axillary approach for total thyroidectomy ensures better identification of recurrent laryngeal nerve (RLN) and PTG on both sides. In addition to using very small incisions, our surgeons "hide" the incision in a natural skin crease which acts like camouflage. Popular incisions included the Lahey incision (Figure 42-1. Consideration should be given to breast size, especially in younger women, as over time the incision will be pulled downward if the breasts are large and pendulous. Next, a vertical cut will be made through the strap-like muscles located just below the skin, and these muscles . Thus, the outcome of substernal goiter surgery is usually good. A thyroid lobectomy may be done for a variety of diseases including indeterminate lesions on fine needle biopsy (See Thyroid Nodules Diagnosis and Treatment ), a toxic nodule (See Hyperthyroidism ), substernal goiter, and an enlarging thyroid nodule, among others. Log In or, Click to share on Twitter (Opens in new window), Click to share on Facebook (Opens in new window), Click to share on Google+ (Opens in new window), on Incisions in Thyroid and Parathyroid Surgery. 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.
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