2011;25:161723. The primary advantage of this surgical procedure is avoidance of an incision on the neck. CAT scan of the chest: This test allows the surgeon to evaluate if the thyroid disease is growing down into the chest and if so, how it is affecting the structures in the chest. 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. Ann Surg Oncol. 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 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. We have been using this approach since 1999. 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. Meanwhile, prospective clinical studies are needed to investigate and validate surgical and oncological outcomes. Our results revealed the complications rate was relatively low and acceptable (Table 2). 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. Department of General Surgery, Xiangya Hospital, Central South University, No. The neck appearance score was low in all cases (either satisfied or very satisfied). 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. They are typically not dangerous unless cancer cells develop in the goitrous thyroid enlargement. E, F Step three, the strap muscles were dissected laterally and the retractor was placed beneath the straps muscle to expose the thyroid lobe. This work was supported by the National Natural Science Foundation of China (grant No. This study kept the confidentiality of patient data and strictly complied with the Declaration of Helsinki and its later amendments or comparable ethical standards. (A and B, Redrawn from Lore JM, Medina JE, editors: Atlas of head and neck surgery, Philadelphia, 2005, Elsevier-Saunders.). 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. However, the rate of complications is higher in individuals older than 60 years of age. Patients may also be given a prescription for thyroid hormone medication (Levothyroxine or Synthroid). 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. It is critical to work with a team of thyroid specialists to choose the right operation for each individual patient. . 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. Objective: To verify the effectiveness and cosmetic results of thyroidectomy through a lateral supraclavicular incision. The supraclavicular lateral collar incision is a feasible and safe approach for thyroidectomy. Transoral thyroidectomy. Fifty-one patients (42 PTC patients and 9 thyroid adenoma patients) were included in this study. However, thyroidectomy is still difficult because the thyroid gland is rich in blood supply and is adjacent to parathyroid glands and important nerves. A, B Step one, dissection of the route to the anterior neck area. What percentage of the human body is water? All authors have no conflicts of interest or financial ties to disclose. 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. Modern thyroid surgery found its origins in the late 19th century in the work of Billroth and Kocher. All existing creases can be mapped out in order to configure an incisional line that is parallel to a regional crease. 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. Lobe TE, Wright SK, Irish MS. Preoperative fine-needle aspiration cytology (FNAC) suggested malignancy in 42 patients, where lobectomy and prophylactic unilateral central neck dissection were performed. No internal jugular vein injury was reported [19]. 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. The mean number of lymph nodes removed by unilateral CND was 3.15 3.2 (range 212) in PTC patients. In conclusion, these results revealed that gasless, endoscopic trans-axillary thyroidectomy is a feasible surgery type with an acceptable safety profile and cosmetic outcomes in strictly selected patients. In each patient, the indication for surgery was a small nodule of unclear malignant potential. Several reports with large case cohorts were regarding robotically assisted thyroidectomy [8,9,10]. 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. This chapter presents historical discussions followed by a series of important guiding principles that serve as fundamental reference points during thyroid and parathyroid surgery incisional design. The size of the incision is dictated by surgeon preference and need for adequate exposure to remove the tumor. 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. We also recommend a multivitamin for most patients. Figure 42-5 Delivery of a thyroid lobe through a minimal access incision (A), which is just big enough to admit the gland. Frontiers | Comparison of Supraclavicular Oblique Incision With 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 . B, C The recurrent laryngeal nerve (RLN) was identified and then traced. Most patients will feel like they have a sore throat for the first few days after the operation, especially when swallowing. Seromas happen rarely and usually disappear within a few weeks. The patients were placed in a supine position while the lesion side limb was extended 90 degrees after general anesthesia. 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). WBX and ZYZ edited the manuscript. The average blood loss was 21.0 26.8 ml (10200 ml). Fada Xia. After a completion thyroidectomy, patients will need to take thyroid hormone replacement pills (one pill a day for the rest of their lives). Dog Cone Alternatives For Post Op - Whole Dog Journal In any case, the incision should be parallel to relaxed skin tension lines, following classic cosmetic principles. 2005;15:64752. 2010;24:18897. 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. Nine patients had solitary or cystic thyroid adenoma, and thus, lobectomy was performed. Patients with other significant medical issues may be asked to visit with their medical team to obtain a letter of medical clearance. ZYZ modified the design of the study. Your incision will be located on the front of your neck. Great efforts are made during surgery to identify and preserve this nerve on both side of the thyroid gland. Thyroidectomy is the most common endocrine surgical procedure performed throughout the world.1 In the city of . Because of the risk of hypertrophic scarring, we recommend resecting a sliver of skin edge whenever and wherever this is recognized (Figure 42-7). The middle thyroid vein was then ligated. A number of important principles are worth considering when planning a thyroidectomy or parathyroidectomy, and these transcend the specific procedure that is anticipated. Approximately 70% of patients who have half of a normal thyroid gland left in place will not require thyroid hormone replacement pills. A special retractor is placed to create a space for the surgeon to remove the thyroid gland. Although the numbers of identified parathyroid glands have not been calculated, we considered that the recognition and protection of the parathyroid gland would get improvement with the growing experience. Rong Cong and Xinying Li contributed equally to this work. The location of the tumor was right, n= 30; left, n= 21. In certain cases, a patient may be asked to spend the night in the hospital. It is often possible for your surgeon to place the incision in an existing skin crease. 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). 2020;34:1891903. Bilateral axillary approach for total thyroidectomy ensures better identification of recurrent laryngeal nerve (RLN) and PTG on both sides. If you are dealing with a thyroid issue, our team at the Columbia Thyroid Center is here to help. 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). To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. 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. It is usually removed in 1-2 days. However, COT normally requires a long collar incision (usually 5-8 cm in length) on the anterior neck [1]. For patients who develop hypertrophic scars, those who develop keloids and persons who want to do everything possible to avoid an incision on the neck, this procedure is possible. Terms and Conditions, Single-port endoscopy-assisted thyroidectomy via cervical gas Due to this rare risk of bleeding, patients are observed for 4 hours by our highly trained recovery room staff. 3). Surgery. Minimally invasive thyroid surgery refers to certain types of surgery in which the thyroid is removed through very small incisions using special techniques. Huang Z, Qin H, Liao J, Meng L, Qin Y, Li B, et al. Some people experience a dull ache, while others feel a sharp pain. Closure of skin incision after thyroidectomy through a supraclavicular . Berber E, Bernet V, Fahey TJ 3rd, Kebebew E, Shaha A, Stack BC Jr, et al. The nodes may be referred to as level 6 lymph nodes based on the AJCC staging criteria. Surgery is typically recommended for goiters that are causing symptoms. Parathyroidectomy The safety of gasless endoscopic trans-axillary thyroid surgery is still undetermined. 2012;42:83541. Most patients (97%) will not notice any change in their voice after the operation. If all 4 glands are injured or removed during the operation, the blood calcium levels can become lower than normal called hypocalcemia. Jiang WJ, Yan PJ, Zhao CL, Si MB, Tian W, Zhang YJ, et al. 2016;26:3317. Medscape. 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. Acceptable wound cosmetology has . 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%. Thyroid cancer is an increasingly prevalent malignancy worldwide [1]. The Procedure of Traditional Low Collar Incision Thyroidectomy The patient was placed in the supine position neck hyperextension. Acceptable wound cosmetology has become a focus for thyroid surgeons. 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). 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. 14,17,18 Indications for OMIT are defined as thyroid volume >30ml but <70-80ml and a dominant nodule . 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. 82073262) and the Hunan Province Natural Science Foundation (grant number 2021JJ41033 and 2019JJ40475). If a patient has symptoms caused by low blood calcium, the surgeon may prescribe extra calcium and a vitamin D supplement. Permanent nerve damage occurs in approximately 1% of cases performed by a skilled surgeon. The median hospital stay was 1.67 0.74 (range 13) days. The natural neck crease as an anatomic landmark for thyroid surgery The 27-year . hXms8+/3@6]H1|p@/IBd`zc[Vx}iJL8t3\bDgX&#&'8N,0f2Pq6PbYD\f(6uiMlJt]#aZal14t FlJNlCO} 2017;27:115864. Thyroidectomy Basics | Epomedicine Written informed consent for publication of their clinical details and clinical images was obtained from all patients. This surgical procedure is known as athyroidectomy. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. Google Scholar. Clinical findings and postoperative complications were analyzed. Correspondence to When present, surgical removal is generally indicated. 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. This procedure ensures patients cosmetic needs by making incisions under the axilla, which allows for the removal of nodules, even large nodules [7]. Kendall Jenner and Bad Bunny arrive at the Mark Hotel before Met Gala If there is no sign of bleeding and the patient feels well, he or she may go home. By contrast, a television commentator with an 11-inch neck (Figure 42-3, A) and a 2-cm follicular neoplasm (Figure 42-3, B) is an ideal candidate for an endoscopic thyroidectomy. also reported a study concerning the gasless trans-axillary thyroidectomy with the assistance of robots. 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. World Journal of Surgical Oncology The size of the incision is dictated by surgeon preference and need for adequate exposure to remove the tumor. B In this case, the hemorrhage of IJV has been controlled by using Harmlock. A 5-6 cm transverse collar skin incision was made into the midline of the anterior neck 2 cm above the sternal notch. This work was supported by the National Natural Science Foundation of China (grant No. 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. 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. This consists of removal of one lobe of the thyroid gland, and the isthmus of the gland. Endoscopic thyroidectomy. The patients were either satisfied or very satisfied with the cosmetic effects. Second, we divided the area between the sternal and clavicular head of the SCM, up to the annular cartilage and down to the clavicle. If the patient was not taking thyroid hormone prior to the operation, the surgeon may prescribe these tablets following surgery. More recently, partly driven by public demand, ever smaller incisions have been utilized (when it can be done safely) in order to improve patient satisfaction, and the procedure is now tailored to the individual condition. Although the risk of these complications cannot be eliminated entirely, they can be minimized in the hands of an experienced thyroid surgeon. Figure 42-1 The Lahey incision (A) affords wide access to the lateral neck, but it is associated with a trifurcation, which is subject to necrosis. Verbal response scores (VRSs) for sensory changes around the anterior chest and paralysis of the SCM (1-week, 1- and 3- month visits) were as follows: 0 = Never, 1 = Sometimes, 2 = Most of the time, 3 = All the time [14]. Surg Endosc. In general, patients may resume taking their normal medications the day after the operation. 2021;19:23. 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. However, the da Vinci system is blamed for a prolonged surgery duration and a significantly higher economic cost. Expert thyroid care for adults and children. This test is used in patients with hoarseness, a previous neck operation, or cases of advanced cancer. 32 0 obj <> endobj As the radical operations of the 1960s and 1970s gave way to the more selective operations of the 1980s and 1990s, neck incisions for thyroid and neck dissection evolved. During the 1850s, operations on the thyroid gland were undertaken via longitudinal, oblique, or vertical neck incisions. In the past decade, efforts were made to reduce incision size and surgical access trauma by the use of endoscopic techniques. Thyroid cancer is an increasingly prevalent malignancy worldwide [].Surgery is the most commonly used technique in treating thyroid diseases. 4). 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]. When this happens, you can trim the edges or let the glue fall off on its own. 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. Meanwhile, the postoperative stiffness and paraesthesia of the SCM can also be ameliorated due to the shorter surgical time, and improved surgical techniques. All data generated or analyzed during this study are included in this published article. Minimally invasive incisions might be placed in the hollow between the medial heads of the sternocleidomastoid muscle. 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. All authors read and approved the final manuscript. It has been pointed out by Kang et al. Gasless single incision trans-axillary thyroidectomy: the feasibility and safety of a hypo-morbid endoscopic thyroidectomy technique. Patients should discuss with their doctors when and if they should restart these medications. If you experience itching once the collodion is off, you may apply lotion to the scar. 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. This suggests that discomfort in the anterior neck area and SCM is obvious shortly after surgery and is relieved over time in most cases. The operation is longer, requires the surgeon operate off a video monitor, and requires assistants to retract the tissues and another assistant to hold the endoscope. Surg Oncol Clin N Am. 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. It is no longer sufficient to remove a thyroid, preserve the laryngeal nerves, and preserve the parathyroid glands (Figure 42-4). Goiters may be a result of the over or underproduction of the thyroid hormone or the presence of nodules in the thyroid gland. American Thyroid Association Statement on Remote-Access Thyroid Surgery. Collar incision was made about 2 1/2cm above the inner ends of the clavicle, through the platysmal muscle. Cong, R., Li, X., Ouyang, H. et al. The dose of thyroid hormone is usually based on the person's weight. Thyroid hormone levels will then be measured about every 2 months until the hormone levels are stable (levels generally stabilize in 4 to 5 months). 1996-2023 MedicineNet, Inc. An Internet Brands company. The midline fascia was divided and strap muscles separated from the thyroid gland. Despite the additional trauma resulting from the flap formation, the application of the trans-axillary approach is of some value in suitable circumstances. Application of lateral supraclavicular incision in unilateral thyroid 2021; https://doi.org/10.1007/s00464-021-08424-y. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. a skin incision was made using scalpel, Short and long-term cosmesis of cervical thyroidectomy scars 2 ). If the seroma is large, the surgeon may drain it with a small needle. 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. Based on this procedure, Kang et al. However, despite careful technique, it is not uncommon to observe skin edges at the end of a procedure (particularly minimally invasive surgery) that are ischemic and traumatized. The PSSs were 1 (very satisfied), 2 (satisfied), 3 (unsatisfied), or 4 (very unsatisfied) [13]. OMIT is an open thyroidectomy performed through a short 'collar' incision and does not necessitate special equipment although two assistants are desirable. It provides a good alternative beyond A number of surgical procedures and surgical approaches have been developed and the terminology can be confusing. WBX and ZYZ drafted the Result, Discussion, and Conclusion sections. 2017;24:R1326. J Laparoendosc Adv Surg Tech A. Temporary nerve damage occurs in 6-8% of cases. 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. Thyroid nodules and cancer management guidelines: comparisons and controversies. Patients should not be worried about hurting their voice by talking. 2). PubMed Central Call (212) 305-0444 for appointments. Symptoms of hypocalcemia include numbness and tingling in your hands, soles of your feet and around your lips. Solved Preop Dx: Cold thyroid nodule Postop Dx: Multinodular - Chegg The operation generally lasts from 2-3 hours. XYL and HOY analyzed the data. Endoscopic and robotic thyroidectomy for cancer. This procedure may also be appropriate for small, non-aggressive thyroid carcinomas less than 1cm. Is Substernal Goiter Surgery Safe? - MedicineNet J Laparoendosc Adv Surg Tech A. They will be monitored closely as they need to recover from the anesthesia. Most people take at least 15-30 days to recover. World J Surg Oncol. 4 Technologic low collar incision 2021;35(7):3540-3546. https://doi.org/10.1007/s00464-020-07814-y. Figure 42-4 Examples of the so-called necklace neck incision associated with a classical thyroidectomy through an open approach (A and B). Anyone you share the following link with will be able to read this content: Sorry, a shareable link is not currently available for this article. Privacy You can shower and wash your hair as usual, but do not soak or scrub the incision. A, An extended low cervical collar incision is used when a lateral neck dissection is indicated. Thyroidectomy without Ligatures in Differentiated Thyroid Cancer A 5- to 7-cm arc incision was made along the dermatoglyphic direction, 1-2 cm above the sternal notch. Rarely, a surgeon may open the sternum (chest) to remove the goiter. 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. The first lymph nodes to be involved are generally the paratracheal lymph nodes. D Thyroid isthmus was dissected. Surg Endosc. Thyroid storm, also called thyrotoxic crisis, is a life-threatening medical emergency caused by very high levels of circulating thyroid hormone. Thyroid cancer can also spread to the lateral neck. 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 + )&`30^2{[b#nuwUhSr e4vMHCH qOmo.S2:uZN|/L.J. The opposite lobe is not removed, and in general the remaining thyroid gland will produce enough thyroid hormone for the body. If the mass is deep inside the chest, the surgeon makes an incision along the middle of the chest bone. In addition to using very small incisions, our surgeons "hide" the incision in a natural skin crease which acts like camouflage.
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