2021; https://doi.org/10.1007/s00464-021-08424-y. Total thyroidectomy (sometimes called near-total thyroidectomy) is the surgical removal of the entire thyroid gland. Manage cookies/Do not sell my data we use in the preference centre. The dose of thyroid hormone is usually based on the person's weight. Surg Endosc. A popular alternative to cones is a post-op surgical/recovery suit. When the goiter is caused by a noncancerous. D Thyroid isthmus was dissected. 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. 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 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. Medscape. Ann Surg Treat Res. However, the risk of damage to this nerve must be understood prior to surgery. Incisions as small as 1 inch (2.5 cm) can be performed for patients with favorable neck anatomy and small tumors. If goiters are not causing any symptoms, the doctor may recommend close observation to monitor for any changes or growth over time. Fada Xia. All authors made substantive intellectual contributions to this study to qualify as authors. The patients were placed in a supine position while the lesion side limb was extended 90 degrees after general anesthesia. This study was reviewed and approved by the Ethics Committee of Xiangya Hospital, Central South University (No. 2012;42:83541. 2021;35(7):3540-3546. https://doi.org/10.1007/s00464-020-07814-y. The neck appearance score (also known as the patient satisfaction score, PSSs) was applied to investigate the cosmetic effects. After surgery, the patient will stay in the recovery room for several hours. However, thyroidectomy is still difficult because the thyroid gland is rich in blood supply and is adjacent to parathyroid glands and important nerves. 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). 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. The size of the incision is dictated by surgeon preference and need for adequate exposure to remove the tumor. In addition to using very small incisions, our surgeons "hide" the incision in a natural skin crease which acts like camouflage. The hockey-stick incision (C) avoids trifurcations and provides plentiful exposure for a comprehensive neck dissection. Perhaps the most important element in optimizing access while maintaining good cosmesis is choosing the proper location for an incision. In the past decade, efforts were made to reduce incision size and surgical access trauma by the use of endoscopic techniques. Medical records were reviewed retrospectively. The parathyroid glands are 4 small, delicate glands each the size of a grain of rice that sit behind the thyroid and control the blood calcium levels. further described gasless endoscopic thyroidectomy through the axillary region, which can effectively avoid the influences of carbon dioxide [8]. 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%. In our study, only two cases had temporary vocal cord paralysis. . 2017;274:495500. No internal jugular vein injury was reported [19]. See our Scar Gallery section for examples of minimally invasive thyroid surgery. J Minim Access Surg. The dissected area is marked in red. As the working space is crucial to the surgery, we have summarized this process in three standard steps. This can also happen after parathyroid surgery. HOW BIG WILL THE INCISION BE? Only two patients developed temporary vocal cord paralysis and no patients developed other severe complications. The neck appearance score was low in all cases (either satisfied or very satisfied). J Laparoendosc Adv Surg Tech A. 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. While the conventional collar incision is widely used, endoscopic thyroidectomy is gradually becoming accepted for thyroid nodule patients with cosmetic needs [2,3,4]. All authors have no conflicts of interest or financial ties to disclose. While the majority of patients accept a thyroidectomy scar, a certain percentage of patients are not satisfied with a visible scar on the neck. 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. By using this website, you agree to our The thyroidectomy (near or total), as we know it today, began in the 1860s with the help of Billroth [ 5 ]. Great efforts are made during surgery to identify and preserve this nerve on both side of the thyroid gland. The sternal head of the SCM was subsequently retracted to expose the strap muscles. Jsls. If the patient was taking thyroid hormone before the operation, they should continue taking the same dose unless it was changed by the surgeon. 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. 2021;99:26775. Injury of internal jugular vein (IJV) in two cases. The average blood loss was 21.0 26.8 ml (10200 ml). 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. In general, patient should be able to eat their normal diet, but most patients prefer softer foods for the first few days. Gasless, endoscopic trans-axillary thyroid surgery: our series of the first 51 human cases. For images of a functional neck dissection, see following images. 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 2 ). Johri G, Chand G, Mishra A, Mayilvaganan S, Agarwal G, Agarwal A, et al. If there is no sign of bleeding and the patient feels well, he or she may go home. Meanwhile, prospective clinical studies are needed to investigate and validate surgical and oncological outcomes. MIVAT combines the small incision with use of endoscopes to help provide illumination and visualization of the tumor. Thyroid cancer is an increasingly prevalent malignancy worldwide [1]. We also recommend a multivitamin for most patients. COT allows good direct exposure for both thyroid lobes and central neck compartment. And their results showed this procedure was feasible with an acceptable safety profile where the need of conversion to conventional thyroidectomy was found in only 2 (0.45%) cases. Due to the working space needed for the flap formation and division of the SCM during an axillary approach, this technique is more time-consuming. It is rare for them to appear after 72 hours. Next, a vertical cut will be made through the strap-like muscles located just below the skin, and these muscles . Thyroid cancer is an increasingly prevalent malignancy worldwide [].Surgery is the most commonly used technique in treating thyroid diseases. n7z0#L1gV>>Z1>~G|s1OG3(dzmJ ')6bF1]/Bpp hbbd``b`$M .$A "H$&X@2`b AzU R\bitiL #3=|` h Due to this rare risk of bleeding, patients are observed for 4 hours by our highly trained recovery room staff. Gasless, endoscopic trans-axillary thyroid surgery: our series of the first 51 human cases, https://doi.org/10.1186/s12957-021-02484-z, https://doi.org/10.1007/s00464-021-08424-y, https://doi.org/10.1007/s00464-020-07814-y, http://creativecommons.org/licenses/by/4.0/, http://creativecommons.org/publicdomain/zero/1.0/. Ryan WR. Indications: Proven neoplasm (FNAC) Suspected neoplasm Age: Extreme Sex: Male There are a number of factors that affect suitability for this procedure. Robotic thyroid surgery using a gasless, transaxillary approach and the da Vinci S system: the operative outcomes of 338 consecutive patients. This surgical procedure is known as athyroidectomy. The risk of having any of these complications depends on the experience of the surgeon. The procedure is not indicated for aggressive thyroid cancers, for very large tumors, or tumors with significant inflammation such as severe Hashimotos thyroiditis, Graves disease, or in patients who are significantly obese or have abnormalities of shoulder function. ZYZ modified the design of the study. The final pathology is ready approximately1 week after the operation. also reported a study concerning the gasless trans-axillary thyroidectomy with the assistance of robots. The paratracheal lymph nodes are divided into pretracheal, prelaryngeal, and right and left lateral paratracheal lymph nodes. This is the result of the blood calcium level dropping below normal (hypocalcemia) and is usually temporary. ~ x>$;oz5/^xJqE_CqK.mu,;L.&?-Y-NM>FyZ-;,pCpfC !DC),!S?Iy,`SDt Cong, R., Li, X., Ouyang, H. et al. World J Surg Oncol. Goiters may be a result of the over or underproduction of the thyroid hormone or the presence of nodules in the thyroid gland. The total mean operative time was 141.6 34.4 min (range 95240 min, from anesthetic intubation to leaving the operating room and entering the postanesthetic care unit (PACU)). Huang Z, Qin H, Liao J, Meng L, Qin Y, Li B, et al. All rights reserved. 4). If a patient has symptoms caused by low blood calcium, the surgeon may prescribe extra calcium and a vitamin D supplement. Lobe TE, Wright SK, Irish MS. A The retractors were used to maintain the working space during the operation. Definition: Thyroidectomy is the surgical removal of all or part of the thyroid gland. 87 Xiangya Road, Changsha, 410008, China, Rong Cong,Xinying Li,Hui Ouyang,Wenbo Xue,Zeyu Zhang&Fada Xia, You can also search for this author in WBX and ZYZ drafted the Result, Discussion, and Conclusion sections. Endoscopic hemithyroidectomy with prophylactic ipsilateral central neck dissection via an unilateral axillo-breast approach without gas insufflation for unilateral micropapillary thyroid carcinoma: preliminary report. Duncan TD, Ejeh IA, Speights F, Rashid QN, Ideis M. Endoscopic transaxillary near total thyroidectomy. volume20, Articlenumber:9 (2022) Mitchem JB, Gillanders WE. 2017;27:115864. In addition to classifying the extent of surgical resection, a number of surgical approaches have been described. Retractor was placed beneath the strap muscles to finish creating the working space (Fig. 2023 BioMed Central Ltd unless otherwise stated. The patient may be positioned with special pillows under the neck to tilt the head back. Prophylactic unilateral central compartment lymph node clearance was conducted. 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. The recurrent laryngeal nerve provides nerve input to the vocal cords, and is also intimately involved with the thyroid gland. Correspondence to 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. Traditionally, parathyroidectomy involved a collar incision, bilateral exploration of the neck, identification of all four glands, and removal of the diseased gland or glands. Privacy Department of General Surgery, Xiangya Hospital, Central South University, No. PubMed Central 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 approach uses smaller incisions in the neck. 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. 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. h. %%EOF 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. 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. Google Scholar. No evidence of recurrence was found during the follow-up period. 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. Acceptable wound cosmetology has become a focus for thyroid surgeons. 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 . This chapter contains additional online-only content, available on expertconsult.com. After showering, pat the incision dry. 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. They have a higher death rate due to postoperative complications. It seems no consensus has been reached on the clinical application of this technique considering the discrepant complications rate. The first lymph nodes to be involved are generally the paratracheal lymph nodes. The total mean operative time of working space make was 44 12.8 min (range 20120 min). Kang JB, Kim EY, Park YL, Park CH, Yun JS. 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. Thyroidectomy incisions have significantly decreased in size since Kocher first popularized his low collar incision in the late 19 th century 4. This test is used in patients with large goiters, substernal goiters, and cases of advanced cancer.

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