Temporary numbness of the anterior chest is very common after this operation, and can last for several months. Call (212) 305-0444 for appointments. The inclusion criteria were as follows: (1) patients with thyroid nodules diagnosed as papillary thyroid cancer (PTC) by ultrasound-guided fine needle aspiration (FNA) before surgerylobectomy (LT) with prophylactic unilateral (ipsilateral) central neck dissection (CND) was performed for these patients; (2) PTC patients with central lymph nodes that were evaluated as negative by two individual professional ultrasound physicians; and (3) patients with benign unilateral nodules with diameters > 4 cm that needed surgical intervention. Mechanical retractors and incision selection. 2005;15:64752. 2009;56:3619. This helps to ensure proper wound healing in the postoperative period. Prophylactic unilateral lymphadenectomy was also routinely performed among patients with thyroid cancer including the prelaryngeal, pretracheal, and ipsilateral paratracheal areas (Fig. Terms and Conditions, Bhargav PR, Kumbhar US, Satyam G, Gayathri KB. If all 4 glands are injured or removed during the operation, the blood calcium levels can become lower than normal called hypocalcemia. Hoarseness generally improves within the first 3 to 4 weeks after the operation but it may take up to 6 months. Robotic thyroid surgery using a gasless, transaxillary approach and the da Vinci S system: the operative outcomes of 338 consecutive patients. In addition to using very small incisions, our surgeons "hide" the incision in a natural skin crease which acts like camouflage. Patients may also be given a prescription for thyroid hormone medication (Levothyroxine or Synthroid). 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]. Cite this article. However, bleeding in the neck is potentially life-threatening because as the blood pools, it can push on the windpipe or trachea causing difficulty breathing. Second, we divided the area between the sternal and clavicular head of the SCM, up to the annular cartilage and down to the clavicle. The thyroidectomy (near or total), as we know it today, began in the 1860s with the help of Billroth [ 5 ]. Single-incision, gasless, endoscopic trans-axillary total thyroidectomy: a feasible and oncologic safe surgery in patients with papillary thyroid carcinoma. The skin and subcutaneous tissues were separated, and subplatysmal . Kang SW, Jeong JJ, Yun JS, Sung TY, Lee SC, Lee YS, et al. n7z0#L1gV>>Z1>~G|s1OG3(dzmJ ')6bF1]/Bpp The primary advantage of this surgical procedure is avoidance of an incision on the neck. The collodion will turn white and start curling up at the edges in about 5 to 7 days. However, the rate of complications is higher in individuals older than 60 years of age. Kang JB, Kim EY, Park YL, Park CH, Yun JS. With careful preoperative testing and thoughtful consideration of the type of anesthesia, including the type of intubation, preparation for surgery can be optimized. 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. 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. This test is used in patients with hoarseness, a previous neck operation, or cases of advanced cancer. 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 safety of gasless endoscopic trans-axillary thyroid surgery is still undetermined. 2006;10:20611. This surgical procedure is known as athyroidectomy. 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. They will be monitored closely as they need to recover from the anesthesia. TR}Iu9!'\2q/ Call (212) 305-0444 or request an appointment online. In the hands of an experienced thyroid surgeon, thyroid surgery is a safe procedure with few complications. statement and In certain cases, the surgeon may choose to perform a near-total thyroidectomy in which a small piece of thyroid tissue is left behind usually in the area of the parathyroid glands and recurrent laryngeal nerve in order to avoid damaging these structures. In the other case, the hemorrhage of IJV has been controlled by using Harmlock clips (Fig. have been classified as minimally invasive. World J Surg Oncol. 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. 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. The risk of having any of these complications depends on the experience of the surgeon. 2021;19:23. XYL and HOY drafted the Methods sections. HOW BIG WILL THE INCISION BE? Injury of internal jugular vein (IJV) in two cases. 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. Fifty-one patients (42 PTC patients and 9 thyroid adenoma patients) were included in this study. Manage cookies/Do not sell my data we use in the preference centre. 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. Objective: To verify the effectiveness and cosmetic results of thyroidectomy through a lateral supraclavicular incision. MIVAT combines the small incision with use of endoscopes to help provide illumination and visualization of the tumor. Clinical findings and postoperative complications of patients who had undergone trans-axillary thyroid surgery due to thyroid cancer and thyroid nodules were retrospectively studied. Medscape. Traditionally, parathyroidectomy involved a collar incision, bilateral exploration of the neck, identification of all four glands, and removal of the diseased gland or glands. Fortunately, in the hands of Columbia Thyroid Center surgeons, the risk of bleeding is less than 1%. Thyroid Nodules Diagnosis and Treatment , Follicular Thyroid Cancer/ Hurthle Cell Carcinoma. The risk of a substernal goiter is higher in people who: 1996-2023 MedicineNet, Inc. An Internet Brands company. 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. Despite the additional trauma resulting from the flap formation, the application of the trans-axillary approach is of some value in suitable circumstances. Indications for this procedure include unilateral goiter and unilateral benign thyroid nodules. also reported a study concerning the gasless trans-axillary thyroidectomy with the assistance of robots. C, D Step two, sternocleidomastoid muscle (SCM) was dissected longitudinally and the sternal head of SCM was elevated by the retractor to expose the strap muscles. In general, patients may resume taking their normal medications the day after the operation. The neck was entered through a collar incision, and bleeding was controlled with electrocautery. In any case, the surgical team must be ready for complications from massive goiter surgery, such as: Substernal goiter can be removed through a relatively straight forward collar incision in the lower neck. 202011960). Lee DY, Oh DJ, Kang KR, Kim MS, Oh KH, Baek SK, et al. 1). 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. At the Columbia Thyroid Center, 95% of our patients are able to go home after a 4 hour observation period in the recovery room. 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. The opposite lobe is not removed, and in general the remaining thyroid gland will produce enough thyroid hormone for the body. 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. Permanent nerve damage occurs in approximately 1% of cases performed by a skilled surgeon. Popular incisions included the Lahey incision (Figure 42-1. 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%. Jantharapattana K, Maethasith J. Transaxillary gasless endoscopic thyroidectomy versus conventional open thyroidectomy: a randomized study. Duncan et al. ~ x>$;oz5/^xJqE_CqK.mu,;L.&?-Y-NM>FyZ-;,pCpfC !DC),!S?Iy,`SDt All rights reserved. We also recommend a multivitamin for most patients. Symptoms of hypocalcemia include numbness and tingling in your hands, soles of your feet and around your lips. Patient concern about cosmetic appearance has led surgeons to explore performing surgery through smaller incisions to extract tumors. 2021;99:26775. The PSSs were 1 (very satisfied), 2 (satisfied), 3 (unsatisfied), or 4 (very unsatisfied) [13]. Patients will receive general anesthesia. The surgical procedure was similar to the methods described by other surgeon groups [11, 12]. 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). The contribution of the incision to the cosmetic outcome does not end with the making of the incision itself. Please see the Expert Consult website for more discussion of this topic. The procedure for thyroidectomy and CND was similar to that of other endoscopic and open approaches. 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. Mitchem JB, Gillanders WE. 2016;23:694700. 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. This chapter contains additional online-only content, available on expertconsult.com. In cases of indeterminate lesions, some surgeons refer to a thyroid lobectomy as a diagnostic lobectomy because the main purpose of the operation is to make a diagnosis cancer or benign thyroid disease. 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. Other risks of thyroid surgery include wound infections and seromas. 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. Only two patients developed temporary vocal cord paralysis and no patient developed permanent vocal cord paralysis. Google Scholar. Patients should not be worried about hurting their voice by talking. Some patients experience a "crawling" sensation in the skin, muscle cramps or headaches. He was able to demonstrate efficacy and efficiency through a low cervical collar incision that bears his name. Our study suggested that the lateral supraclavicular incision is a safe and practical approach for thyroidectomy. The parathyroid glands control calcium homeostasis within the body. 2021; https://doi.org/10.1007/s00464-021-08424-y. 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, hXms8+/3@6]H1|p@/IBd`zc[Vx}iJL8t3\bDgX&#&'8N,0f2Pq6PbYD\f(6uiMlJt]#aZal14t FlJNlCO} 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. Routine level 2b dissection may be recommended only in N1b papillary thyroid carcinoma with three- or four-level lateral lymph node metastasis. In this study, we reported our initial experiences with 51 patients who underwent gasless endoscopic trans-axillary thyroid surgery performed by a single experienced surgeon. Surg Endosc. 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. Clinical findings and postoperative complications were analyzed. Ann Surg Treat Res. Your incision will be located on the front of your neck. The neck appearance score was low in all cases (either satisfied or very satisfied). Classically, standard thyroid lobectomy or thyroidectomy has been performed through an incision low in the neck called the low collar incision. 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. After surgery, the patient will stay in the recovery room for several hours. 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. These symptoms appear between 24 and 48 hours after surgery. 2013;9:11621. You can shower and wash your hair as usual, but do not soak or scrub the incision. Gasless single incision trans-axillary thyroidectomy: the feasibility and safety of a hypo-morbid endoscopic thyroidectomy technique. If the voice is still hoarse after 3 to 6 months, the surgeon may prescribe voice-strengthening exercises or ask the patient to visit with a voice specialist for evaluation. 2023 BioMed Central Ltd unless otherwise stated. If any of these symptoms happen, the patient should call 911 first and then their surgeon. A tube may be left in place to drain fluid and blood. 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. Huang Z, Qin H, Liao J, Meng L, Qin Y, Li B, et al. 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. This approach involves making an incision in the center of your neck to directly access your thyroid gland. &P3J&lwT,Y+noVac?GEbd1ygA( This work was supported by the National Natural Science Foundation of China (grant No. Some people experience a dull ache, while others feel a sharp pain. The average blood loss for this operation is less than a tablespoon and the chance of needing a blood transfusion is extremely rare. Bleeding is a rare complication and those few patients who do have a bleeding problem almost always have it during the 4 hour observation period in the recovery room. Although researchers made some efforts to achieve it by sectioning the sternohyoid muscle, the long operation duration, pain in the neck, and swallowing discomfort should also be taken into consideration. Written informed consent for publication of their clinical details and clinical images was obtained from all patients. 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. A The superior thyroid vessels were individually ligated. No evidence of recurrence was found during the follow-up period. 2021;35(7):3540-3546. https://doi.org/10.1007/s00464-020-07814-y. 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. Thyroid cancer is an increasingly prevalent malignancy worldwide [].Surgery is the most commonly used technique in treating thyroid diseases. Endoscopic hemithyroidectomy with prophylactic ipsilateral central neck dissection via an unilateral axillo-breast approach without gas insufflation for unilateral micropapillary thyroid carcinoma: preliminary report. When the goiter is caused by a noncancerous. All goiters are then removed. revealed that trans-axillary thyroidectomy was associated with a better cosmetic index, however, it was also associated with a longer operation time, aggravated voice changes, paresthesia, and changes in swallowing function [18].