Gasless, endoscopic trans-axillary thyroid surgery: our series of the first 51 human cases. Due to this rare risk of bleeding, patients are observed for 4 hours by our highly trained recovery room staff. 2011;25:161723. %%EOF 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. Thyroid cancer is an increasingly prevalent malignancy worldwide [].Surgery is the most commonly used technique in treating thyroid diseases. further described gasless endoscopic thyroidectomy through the axillary region, which can effectively avoid the influences of carbon dioxide [8]. In general, patient should be able to eat their normal diet, but most patients prefer softer foods for the first few days. Transoral thyroidectomy. Clinical findings and postoperative complications of patients who had undergone trans-axillary thyroid surgery due to thyroid cancer and thyroid nodules were retrospectively studied. Kang JB, Kim EY, Park YL, Park CH, Yun JS. Thus, the outcome of substernal goiter surgery is usually good. During the procedure: Goiters are noncancerous enlargement of the thyroid gland. This helps to ensure proper wound healing in the postoperative period. hb`````Jg`a`6Tcg@ ~+s\``fy$ S@5@YN@ZA:V^`` HWy6rC+1oxD7`v`Xvz&fq=@&2` &{^j@ 8S Ann Surg Oncol. Your incision is covered with a protective strip of clear glue called collodion. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. Duncan TD, Ejeh IA, Speights F, Rashid QN, Ideis M. Endoscopic transaxillary near total thyroidectomy. 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. Ryan WR. Google Scholar. It is critical to work with a team of thyroid specialists to choose the right operation for each individual patient. Even in the rare chance of having a permanently hoarse voice, there are things that can be done to improve or fix the voice. If you experience itching once the collodion is off, you may apply lotion to the scar. 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. Comparison between 3-dimensional and 2-dimensional endoscopic thyroidectomy for benign and malignant lesions: a meta-analysis. Surg Oncol Clin N Am. 2013;22:113. 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. Acceptable wound cosmetology has . Single-incision, gasless, endoscopic trans-axillary total thyroidectomy: a feasible and oncologic safe surgery in patients with papillary thyroid carcinoma. Surgery is typically recommended for goiters that are causing symptoms. Terms and Conditions, Gasless single incision trans-axillary thyroidectomy: the feasibility and safety of a hypo-morbid endoscopic thyroidectomy technique. Excellent long-term cosmetic outcomes can be expected with minimally invasive endoscopic thyroid surgery (B). It provides a good alternative beyond See our Scar Gallery section for examples of minimally invasive thyroid surgery. We also recommend a multivitamin for most patients. Most patients (97%) will not notice any change in their voice after the operation. 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. Have certain genes or a family member with goiters. Thyroid storm, also called thyrotoxic crisis, is a life-threatening medical emergency caused by very high levels of circulating thyroid hormone. 1999-2022. 2021;99:26775. (A and B, Redrawn from Lore JM, Medina JE, editors: Atlas of head and neck surgery, Philadelphia, 2005, Elsevier-Saunders.). At the Columbia Thyroid Center, 95% of our patients are able to go home after a 4 hour observation period in the recovery room. 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). Your incision will be located on the front of your neck. Duncan et al. World J Surg. Definition: Thyroidectomy is the surgical removal of all or part of the thyroid gland. also reported a study concerning the gasless trans-axillary thyroidectomy with the assistance of robots. However, the risk of damage to this nerve must be understood prior to surgery. Rarely, a patient may have temporary changes in the voice such as fluctuations in volume and clarity (hoarseness). 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. After a completion thyroidectomy, patients will need to take thyroid hormone replacement pills (one pill a day for the rest of their lives). Figure 42-5 Delivery of a thyroid lobe through a minimal access incision (A), which is just big enough to admit the gland. Endocr J. Temporary hoarseness usually gets better within a few weeks, but can take up to 6 months to resolve. The patient is usually given general anesthesia to numb the. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Ann Surg Oncol. Surg Today. The exceptions are blood thinners, aspirin, Plavix, and anti-thyroid medications like PTU and Methimazole. However, thyroidectomy is still difficult because the thyroid gland is rich in blood supply and is adjacent to parathyroid glands and important nerves. A 5- to 7-cm arc incision was made along the dermatoglyphic direction, 1-2 cm above the sternal notch. 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. 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. 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, The dissected area is marked in red. Kang SW, Lee SC, Lee SH, Lee KY, Jeong JJ, Lee YS, et al. 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. From July 2020 to March 2021, 51 patients (49 females and 2 males) underwent operations by gasless, endoscopic trans-axillary approaches, with one patient whose operation was converted to open surgery because of internal jugular vein injury. Springer Nature. All authors have agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. 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. The patients were either satisfied or very satisfied with the cosmetic effects. During the 1850s, operations on the thyroid gland were undertaken via longitudinal, oblique, or vertical neck incisions. As the sternal head of the SCM was elevated by the retractor during the procedure, the decreased VRSs may be partly due to the shorter surgical time and improved surgical techniques. J Laparoendosc Adv Surg Tech A. The rate of permanently low calcium levels after a total thyroidectomy is anywhere from 1-5%. 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. The skin and subcutaneous tissues were separated, and subplatysmal . Our study suggested that the lateral supraclavicular incision is a safe and practical approach for thyroidectomy. Traditionally, parathyroidectomy involved a collar incision, bilateral exploration of the neck, identification of all four glands, and removal of the diseased gland or glands. have been classified as minimally invasive. One must be cautious that normal creases may (especially in the more lateral portion of the neck) become asymmetrical and even V like in nature, rather than the more symmetrical rounded creases of the lower central neck. Substernal goiter can be removed through a relatively straightforward collar incision in the lower neck. A portion of the enlarged thyroid (if possible) or the entire thyroid gland may need to be removed. Minimally Invasive Thyroid Surgery 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. COVID-19 News: Vaccine Info | In Person Visits | Virtual Visits. In this operation, an incision is made in the axilla (armpit) and dissection is carried superiorly across the collar bone into the neck. If a patient has symptoms caused by low blood calcium, the surgeon may prescribe extra calcium and a vitamin D supplement. 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. C and D, Both the right and the left neck may be thoroughly dissected with appropriate retraction assistance. A The retractors were used to maintain the working space during the operation. If symptoms of hypocalcemia develop, take an extra two Tums Ultra 1000 tablets and if the symptoms do not go away after 30 minutes, call your doctor. For this purpose, a drain is often left in place for one to several days after surgery to help evacuate any blood in the area. Patients should call their surgeon's office to make a follow up appointment 3 weeks after surgery. Patients in two groups underwent thyroidectomy through a supraclavicular lateral collar incision (approximately 5 cm). The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. 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. Moreover, the patients arm is raised during the entire operation time which might cause pain in the axilla [20, 21]. The final pathology is ready approximately1 week after the operation. J Laparoendosc Adv Surg Tech A. Fortunately, in the hands of Columbia Thyroid Center surgeons, the risk of bleeding is less than 1%. The average blood loss for this operation is less than a tablespoon and the chance of needing a blood transfusion is extremely rare. The paratracheal lymph nodes are divided into pretracheal, prelaryngeal, and right and left lateral paratracheal lymph nodes. All authors read and approved the final manuscript. All goiters are then removed. This technique can be performed on incisions as small as 2.0 cm (0.8 inches), and generally has excellent healing and cosmetic result. 2.5cm . 202011960). A completion thyroidectomy is usually done after a thyroid lobectomy reveals cancer in the first half of the thyroid but may also be done for multinodular goiter or hyperthyroidism. Examples of the so-called necklace neck incision associated with a classical thyroidectomy through an open approach (, Delivery of a thyroid lobe through a minimal access incision. 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 . Specific procedural considerations are described, and then a concise enumeration of proposed best practices is offered. Jsls. The Thyroid Center recommends taking Tylenol, Motrin, or Advil as the bottle directs around the clock for the first few days (as long as their overall health allows it). Classically 8-12 cm (3-5 inch) incisions were performed. XYL and HOY analyzed the data. MedicineNet does not provide medical advice, diagnosis or treatment. 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. 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. The parathyroid glands control calcium homeostasis within the body. The primary advantage of this surgical procedure is avoidance of an incision on the neck. As the working space is crucial to the surgery and time-consuming, the time of working space makes and thyroidectomy were calculated separately. They are typically not dangerous unless cancer cells develop in the goitrous thyroid enlargement. Jules Boeckel of Strasbourg introduced the collar incision to thyroid. None of the patients developed hypoparathyroidism, esophageal injury, or surgical site infection after the surgery. 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. Fada Xia. The mean number of lymph nodes removed by unilateral CND was 3.15 3.2 (range 212) in PTC patients. In certain cases, a patient may be asked to spend the night in the hospital. 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. Minimally invasive incisions might be placed in the hollow between the medial heads of the sternocleidomastoid muscle. Moreno Llorente P, E AGL, Alberich Prats M, Francos Martnez JM, Garca Barrasa A. Surgical approaches to thyroid. Endoscopic and robotic thyroidectomy for cancer. The sternal head of the SCM was subsequently retracted to expose the strap muscles. It is prudent to resect a sliver of skin edge on either or both sides of the incision (B), which leads to a more predictable healing result and minimizes the risk of hypertrophic scarring. During the limited follow-up periods, no recurrence has been found. MedicineNet does not provide medical advice, diagnosis or treatment. 2017;274:495500. 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. Lee DY, Oh DJ, Kang KR, Kim MS, Oh KH, Baek SK, et al. We also recommend a multivitamin for most patients. The operation generally lasts from 2-3 hours. The Procedure of Traditional Low Collar Incision Thyroidectomy The patient was placed in the supine position neck hyperextension. If the mass is deep inside the chest, the surgeon makes an incision along the middle of the chest bone. Figure 42-7 When a large thyroid lobe is delivered through small incisions, it is not uncommon to observe evidence of an ischemic or traumatized skin edge (A). It is often possible for your surgeon to place the incision in an existing skin crease. Approximately 70% of patients who have half of a normal thyroid gland left in place will not require thyroid hormone replacement pills. A, B Step one, dissection of the route to the anterior neck area. Cookies policy. The patient may be positioned with special pillows under the neck to tilt the head back. Bhargav PR, Kumbhar US, Satyam G, Gayathri KB. Perhaps the most important element in optimizing access while maintaining good cosmesis is choosing the proper location for an incision. The patients were placed in a supine position while the lesion side limb was extended 90 degrees after general anesthesia. This nonobese gentleman who has a 26-inch neck circumference and a large goiter would not be a candidate for any minimally invasive approach. Rarely, a surgeon may open the sternum (chest) to remove the goiter. There is no clear definition of what minimally invasive means, and surgical incisions as large as 6 cm. 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. When the goiter is caused by a noncancerous. J Minim Access Surg. The mean age was 34 years old, ranging from 19 to 45 years. Conventional thyroidectomy In a conventional thyroidectomy, a 3- to 4-inch incision will be made through the skin in the low collar area of your neck (the lower front portion of your neck, above the collarbones and breast bone). 2013;9:11621. Minimally invasive thyroidectomy is a surgical approach to remove the thyroid gland through smaller incisions. 2021;19:23. Patient concern about cosmetic appearance has led surgeons to explore performing surgery through smaller incisions to extract tumors. We have been using this approach since 1999. Thyroidectomy incisions have significantly decreased in size since Kocher first popularized his low collar incision in the late 19 th century 4. Based on this procedure, Kang et al. This work was supported by the National Natural Science Foundation of China (grant No. After surgery, the patient will stay in the recovery room for several hours. Clinical findings and postoperative complications were analyzed. Patients will receive general anesthesia. To date, conventional open thyroidectomy through a collar incision is the standard approach to thyroidectomy (4). It is noteworthy that there is another obvious disadvantage of this technique. Medication to normalize abnormal thyroid hormone levels may help decrease the size of goiters. This will disappear over the next 3 to 6 months. 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). Thyroid cancer is an increasingly prevalent malignancy worldwide [1]. low collar incision 82073262) and the Hunan Province Natural Science Foundation (grant number 2019JJ40475). Over a hundred thousand thyroid surgeries are performed per year in the United States. Most people take at least 15-30 days to recover. Most thyroid nodules are small, and performing a full collar incision is not necessary to provide needed surgical exposure to safely remove the thyroid lobe. While the majority of patients accept a thyroidectomy scar, a certain percentage of patients are not satisfied with a visible scar on the neck. The average drainage volume was 48.0 24.4 ml (20100 ml) on day one and 13.7 5.6 ml (1030 ml) on day two. 14,17,18 Indications for OMIT are defined as thyroid volume >30ml but <70-80ml and a dominant nodule . 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. The size of the incision is dictated by surgeon preference and need for adequate exposure to remove the tumor. 2016;23:694700. The total mean operative time of working space make was 44 12.8 min (range 20120 min). D Thyroid isthmus was dissected. Minimally invasive thyroid surgery refers to certain types of surgery in which the thyroid is removed through very small incisions using special techniques.

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