A, B Step one, dissection of the route to the anterior neck area. 2.5cm . A more in-depth study of the learning curve of the procedure via the TA approach is urgently needed. In any case, the incision should be parallel to relaxed skin tension lines, following classic cosmetic principles. 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. If a patient has symptoms caused by low blood calcium, the surgeon may prescribe extra calcium and a vitamin D supplement. 202011960). Part of The hockey-stick incision (C) avoids trifurcations and provides plentiful exposure for a comprehensive neck dissection. 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. 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]. However, the risk of damage to this nerve must be understood prior to surgery. Most people take at least 15-30 days to recover. We also recommend a multivitamin for most patients. Cookies policy. 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. 2009;146:104855. This test is used in patients with large goiters, substernal goiters, and cases of advanced cancer. Clinical findings and postoperative complications of patients who had undergone trans-axillary thyroid surgery due to thyroid cancer and thyroid nodules were retrospectively studied. This hardening will peak at about 3 weeks and may result in some tightness especially when swallowing or extending your neck. 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. The addition of robotics can improve surgical dexterity in a difficult-to-reach anatomic region [6]. Surgery. UC Irvine Department of Head & Neck Surgery, 101 The City Drive South Pavilion II Orange, CA 92868, UCI Head & Neck UCI - Audiology Department, UC Irvine Health 101 The City Drive South, Orange, CA 92868, Petrous Apex Lesions, Cholesterol Granuloma, Cyst, Cholesteatoma, Radiosurgery (CyberKnife for Skull Base Tumors or Acoustic Neuromas), Acoustic Neuroma Orange County Los Angeles Southern California, Congenital Atresia of the Ear (Non-Development of the Ear Canal), Minimally Invasive Endoscopic Skull Base Surgery, Otosclerosis Orange County, Los Angeles, Southern California, Surgical Treatment of the Tongue and Lower Throat, Independent Medical Evaluation / Workers Compensation. See additional information. 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. Indications: Proven neoplasm (FNAC) Suspected neoplasm Age: Extreme Sex: Male further described gasless endoscopic thyroidectomy through the axillary region, which can effectively avoid the influences of carbon dioxide [8]. 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. Temporary numbness of the anterior chest is very common after this operation, and can last for several months. The middle thyroid vein was then ligated. A seroma is a collection of fluid under the incision. If any of these symptoms happen, the patient should call 911 first and then their surgeon. Some patients experience a "crawling" sensation in the skin, muscle cramps or headaches. Minimally invasive thyroid surgery refers to certain types of surgery in which the thyroid is removed through very small incisions using special techniques. Jantharapattana K, Maethasith J. Transaxillary gasless endoscopic thyroidectomy versus conventional open thyroidectomy: a randomized study. The PSSs were 1 (very satisfied), 2 (satisfied), 3 (unsatisfied), or 4 (very unsatisfied) [13]. Perhaps the most important element in optimizing access while maintaining good cosmesis is choosing the proper location for an incision. Nabhan F, Ringel MD. 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. For example, a gentleman with a 26-inch neck (Figure 42-2. Huang Z, Qin H, Liao J, Meng L, Qin Y, Li B, et al. Patients should call their surgeon's office to make a follow up appointment 3 weeks after surgery. Koh YW, Park JH, Kim JW, Lee SW, Choi EC. The supraclavicular lateral collar incision is a feasible and safe approach for thyroidectomy. After surgery, the patient will stay in the recovery room for several hours. Great efforts are made during surgery to identify and preserve this nerve on both side of the thyroid gland. Gasless, endoscopic trans-axillary thyroid surgery: our series of the first 51 human cases. A comparison of postoperative pain after conventional open thyroidectomy and single-incision, gasless, endoscopic transaxillary thyroidectomy: a single institute prospective study. PubMed While the conventional collar incision is widely used, endoscopic thyroidectomy is gradually becoming accepted for thyroid nodule patients with cosmetic needs [2,3,4]. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. 2016;26:3317. The neck appearance score (also known as the patient satisfaction score, PSSs) was applied to investigate the cosmetic effects. No internal jugular vein injury was reported [19]. Nine patients had solitary or cystic thyroid adenoma, and thus, lobectomy was performed. 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. Terms of Use. This technique can be performed on incisions as small as 2.0 cm (0.8 inches), and generally has excellent healing and cosmetic result. It is usually removed in 1-2 days. 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. 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. Specific procedural considerations are described, and then a concise enumeration of proposed best practices is offered. While the conventional collar incision is widely used, endoscopic thyroidectomy is gradually becoming accepted for thyroid nodule patients with cosmetic needs [2,3,4].Under the premise of oncological effectiveness, endoscopic thyroidectomy can provide a . The optimal position in which to mark the anticipated thyroid incision is with the patient seated upright in the holding area. Rarely, a surgeon may open the sternum (chest) to remove the goiter. All data generated or analyzed during this study are included in this published article. 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). The neck appearance score was low in all cases (either satisfied or very satisfied). During the 1850s, operations on the thyroid gland were undertaken via longitudinal, oblique, or vertical neck incisions. This procedure may also be appropriate for small, non-aggressive thyroid carcinomas less than 1cm. Mechanical retractors and incision selection. The decision as to which thyroid operation to perform depends on a number of factors including the type of disease and the patient's preferences. This approach accesses the thyroid through an incision inside the mouth. Classically, standard thyroid lobectomy or thyroidectomy has been performed through an incision low in the neck called the low collar incision. J Minim Access Surg. Figure 42-5 Delivery of a thyroid lobe through a minimal access incision (A), which is just big enough to admit the gland. In general, patient should be able to eat their normal diet, but most patients prefer softer foods for the first few days. Figure 42-4 Examples of the so-called necklace neck incision associated with a classical thyroidectomy through an open approach (A and B). 1). hb`````Jg`a`6Tcg@ ~+s\``fy$ S@5@YN@ZA:V^`` HWy6rC+1oxD7`v`Xvz&fq=@&2` &{^j@ 8S Thyroid. 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. Fifty-one patients (42 PTC patients and 9 thyroid adenoma patients) were included in this study. 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. https://emedicine.medscape.com/article/2051665-overview. Cong, R., Li, X., Ouyang, H. et al. J Laparoendosc Adv Surg Tech A. The procedure is not indicated for aggressive thyroid cancers, for very large tumors, or tumors with significant inflammation such as severe Hashimotos thyroiditis, Graves disease, or in patients who are significantly obese or have abnormalities of shoulder function. Modern thyroid surgery found its origins in the late 19th century in the work of Billroth and Kocher. If all 4 glands are injured or removed during the operation, the blood calcium levels can become lower than normal called hypocalcemia. 2013;9:11621. Surg Oncol Clin N Am. This chapter contains additional online-only content, available on expertconsult.com. In our study, only two cases had temporary vocal cord paralysis. 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. Patients who spend the night in the hospital are typically discharged by 10AM the next morning. A portion of the enlarged thyroid (if possible) or the entire thyroid gland may need to be removed. 4 Also emerging are techniques for remote access thyroid and Ann Surg Treat Res. Sensory changes around the anterior chest and paralysis of the sternocleidomastoid muscle were evaluated by VRSs. Second, we divided the area between the sternal and clavicular head of the SCM, up to the annular cartilage and down to the clavicle. A questionnaire regarding the sensory changes around the anterior chest, paralysis of the SCM, and satisfaction with cosmesis was used to evaluate the quality of life in enrolled patients. Jiang WJ, Yan PJ, Zhao CL, Si MB, Tian W, Zhang YJ, et al. 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%. 82073262) and the Hunan Province Natural Science Foundation (grant number 2021JJ41033 and 2019JJ40475). In addition to classifying the extent of surgical resection, a number of surgical approaches have been described. Bhargav PR, Kumbhar US, Satyam G, Gayathri KB. Piccoli et al. Surgery is typically recommended for goiters that are causing symptoms. In these cases, the voice will often be better in the mornings and "tire" toward the end of the day. It is uncommon, but when it occurs after thyroidectomy, it is usually associated with Grave's disease. . Over a hundred thousand thyroid surgeries are performed per year in the United States. 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. 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. The midline fascia was divided and strap muscles separated from the thyroid gland. A number of surgical procedures and surgical approaches have been developed and the terminology can be confusing. This will disappear over the next 3 to 6 months. Patients will receive general anesthesia. 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). 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. 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. Thyroid Nodules Diagnosis and Treatment , Follicular Thyroid Cancer/ Hurthle Cell Carcinoma. As the scar heals, it will appear to be part of the crease and thus camouflage it. Most people will not be able to notice the incision once the redness fades away. Incisions as small as 1 inch (2.5 cm) can be performed for patients with favorable neck anatomy and small tumors. There are a number of factors that affect suitability for this procedure. 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.