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. Clinical findings and postoperative complications were analyzed. 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. It is uncommon, but when it occurs after thyroidectomy, it is usually associated with Grave's disease. 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. Surg Endosc. When present, surgical removal is generally indicated. Cite this article. 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. This technique can be performed on incisions as small as 2.0 cm (0.8 inches), and generally has excellent healing and cosmetic result. 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. If the patient was not taking thyroid hormone prior to the operation, the surgeon may prescribe these tablets following surgery. If any of these symptoms happen, the patient should call 911 first and then their surgeon. qDH z(a;Lq#t For example, a gentleman with a 26-inch neck (Figure 42-2. A The superior thyroid vessels were individually ligated. A number of technological advances such as advanced energy devices for hemostasis. Furthermore, the sensory change and paralysis results from this technique and patients satisfaction with the cosmesis were also studied. Please see the Expert Consult website for more discussion of this topic, including Figure 42-1. 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. . Collar incision was made about 2 1/2cm above the inner ends of the clavicle, through the platysmal muscle.. 2.5cm . . Patients may also be given a prescription for thyroid hormone medication (Levothyroxine or Synthroid). This test is used in patients with large goiters, substernal goiters, and cases of advanced cancer. 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. WBX and ZYZ edited the manuscript. First, we dissected the tunnel to the anterior neck area with exposure of the sternocleidomastoid muscle (SCM). However, the rate of complications is higher in individuals older than 60 years of age. Meanwhile, prospective clinical studies are needed to investigate and validate surgical and oncological outcomes. Over a hundred thousand thyroid surgeries are performed per year in the United States. It has been pointed out by Kang et al. 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 It is important to note that numbness and tingling may be caused by something other than a parathyroid problem. Next, an endoscope with two cameras that produce three-dimensional viewing is inserted into the incision, and three robotic arms are inserted into the incision. Minimally invasive incisions might be placed in the hollow between the medial heads of the sternocleidomastoid muscle. If you experience itching once the collodion is off, you may apply lotion to the scar. Written informed consent for publication of their clinical details and clinical images was obtained from all patients. All authors have no conflicts of interest or financial ties to disclose. Classically 8-12 cm (3-5 inch) incisions were performed. Retractor was placed beneath the strap muscles to finish creating the working space (Fig. 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 hardening will peak at about 3 weeks and may result in some tightness especially when swallowing or extending your neck. This percent decreases in older women, patients with a personal or family history of Hashimoto's thyroiditis or hypothyroidism, and patients with a family history of autoimmune disease. In this way, the incision can be planned with the patients input and awareness. To date, conventional open thyroidectomy through a collar incision is the standard approach to thyroidectomy (4). This work was supported by the National Natural Science Foundation of China (grant No. Rarely, nerve injury to the arm can occur, resulting in impaired arm and/or hand function. Thyroid cancer is an increasingly prevalent malignancy worldwide [].Surgery is the most commonly used technique in treating thyroid diseases. 2016;23:694700. volume20, Articlenumber:9 (2022) 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. The average blood loss was 21.0 26.8 ml (10200 ml). The surgical drain was removed 2 days after surgery in all cases. Piccoli et al. 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. Statistical analyses were conducted using the Students t test and one-way ANOVA through the SPSS 23.0 software. Ann Surg Oncol. Endocr Relat Cancer. This nonobese gentleman who has a 26-inch neck circumference and a large goiter would not be a candidate for any minimally invasive approach. COVID-19 News: Vaccine Info | In Person Visits | Virtual Visits. Temporary numbness of the anterior chest is very common after this operation, and can last for several months. 82073262) and the Hunan Province Natural Science Foundation (grant number 2021JJ41033 and 2019JJ40475). 1999-2022. 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. This approach involves making an incision in the center of your neck to directly access your thyroid gland. https://doi.org/10.1186/s12957-021-02484-z, DOI: https://doi.org/10.1186/s12957-021-02484-z. Bilateral axillary approach for total thyroidectomy ensures better identification of recurrent laryngeal nerve (RLN) and PTG on both sides. Rarely, a surgeon may open the sternum (chest) to remove the goiter. 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. 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 portion of the enlarged thyroid (if possible) or the entire thyroid gland may need to be removed. 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. &P3J&lwT,Y+noVac?GEbd1ygA( The paratracheal lymph nodes are divided into pretracheal, prelaryngeal, and right and left lateral paratracheal lymph nodes. The retractors (Kangji, Hangzhou, China) were used to maintain the working space during the operation. Patients will receive general anesthesia. Despite the additional trauma resulting from the flap formation, the application of the trans-axillary approach is of some value in suitable circumstances. All goiters are then removed. 2021;35(7):3540-3546. https://doi.org/10.1007/s00464-020-07814-y. Gasless single incision trans-axillary thyroidectomy: the feasibility and safety of a hypo-morbid endoscopic thyroidectomy technique. 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. Skin flaps were created deep to the platysma up to the hyoid bone and down to the suprastemal notch. The system also has tremor filtration and scaling of movements to eliminate tremor and allow very fine microsurgical movements if needed. This helps to ensure proper wound healing in the postoperative period. Terms of Use. 4). The surgeon makes a cut (incision) in the lower part of the neck just above the collar bone to determine if the mass can be removed without opening the chest. (A and B, Redrawn from Lore JM, Medina JE, editors: Atlas of head and neck surgery, Philadelphia, 2005, Elsevier-Saunders.). further described gasless endoscopic thyroidectomy through the axillary region, which can effectively avoid the influences of carbon dioxide [8]. Excellent long-term cosmetic outcomes can be expected with minimally invasive endoscopic thyroid surgery (B). MIVAT combines the small incision with use of endoscopes to help provide illumination and visualization of the tumor. Several reports with large case cohorts were regarding robotically assisted thyroidectomy [8,9,10]. Surg Today. Surg Endosc. For persons with pre-existing shoulder abnormalities, these could be exacerbated by surgery. . The primary advantage of this surgical procedure is avoidance of an incision on the neck. Most of the time, the surgery can be done this way. Surg Oncol Clin N Am. Duncan TD, Ejeh IA, Speights F, Rashid QN, Ideis M. Endoscopic transaxillary near total thyroidectomy. No evidence of recurrence was found during the follow-up period. Kang JB, Kim EY, Park YL, Park CH, Yun JS. 2012;42:83541. If all 4 glands are injured or removed during the operation, the blood calcium levels can become lower than normal called hypocalcemia. Other risks of thyroid surgery include wound infections and seromas. 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. After showering, pat the incision dry. Some patients experience a "crawling" sensation in the skin, muscle cramps or headaches. Prophylactic unilateral lymphadenectomy was also routinely performed among patients with thyroid cancer including the prelaryngeal, pretracheal, and ipsilateral paratracheal areas (Fig. 2021; https://doi.org/10.1007/s00464-021-08424-y. statement and 82073262) and the Hunan Province Natural Science Foundation (grant number 2019JJ40475). This study was reviewed and approved by the Ethics Committee of Xiangya Hospital, Central South University (No. This suggests that discomfort in the anterior neck area and SCM is obvious shortly after surgery and is relieved over time in most cases. 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 supraclavicular lateral collar incision is a feasible and safe approach for thyroidectomy. Due to this rare risk of bleeding, patients are observed for 4 hours by our highly trained recovery room staff. 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. Please see the Expert Consult website for more discussion of this topic. In the past decade, advancements in A c c e p t e d . endstream endobj 33 0 obj <>>> endobj 34 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text/ImageC]/XObject<>>>/Rotate 0/Thumb 11 0 R/TrimBox[0.0 0.0 612.0 792.0]/Type/Page>> endobj 35 0 obj <>stream 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. Some people experience a dull ache, while others feel a sharp pain. All authors read and approved the final manuscript. 2021;19:23. Chen GZ, Zhang X, Shi WL, Zhuang ZR, Chen X, Han H. Systematic comparison of cervical and extra-cervical surgical approaches for endoscopic thyroidectomy. Specific procedural considerations are described, and then a concise enumeration of proposed best practices is offered. Patients with other significant medical issues may be asked to visit with their medical team to obtain a letter of medical clearance. Feeling that something is stuck in the throat. Nabhan F, Ringel MD. Total thyroidectomy (sometimes called near-total thyroidectomy) is the surgical removal of the entire thyroid gland. 2021;99:26775. 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. A 5-6 cm transverse collar skin incision was made into the midline of the anterior neck 2 cm above the sternal notch. Comparison of learning curves for retroauricular and transaxillary endoscopic hemithyroidectomy. Figure 42-6 The optimal position in which to mark the anticipated thyroid incision is with the patient seated upright in the holding area. 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. Surg Endosc. 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. How helpful the three-dimensional endoscopy or robotic endoscopy to the completion of bilateral (total) thyroidectomy via trans-axillary approach is worth further exploration. 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.
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