Our results revealed the complications rate was relatively low and acceptable (Table 2). 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. The follow-up times were 3 to 10 months. HOW BIG WILL THE INCISION BE? This test is used in patients with large goiters, substernal goiters, and cases of advanced cancer. 2021;99:26775. Patients should call their surgeon's office to make a follow up appointment 3 weeks after surgery. Temporary nerve damage occurs in 6-8% of cases. After the seventh day, reduce the calcium to one Tums Ultra 1000 tablet three times a day until your follow-up appointment. https://doi.org/10.1186/s12957-021-02484-z, DOI: https://doi.org/10.1186/s12957-021-02484-z. 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. 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. Thus, the outcome of substernal goiter surgery is usually good. OMIT is an open thyroidectomy performed through a short 'collar' incision and does not necessitate special equipment although two assistants are desirable. The risk of having any of these complications depends on the experience of the surgeon. Your incision is covered with a protective strip of clear glue called collodion. 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. Goiters may be a result of the over or underproduction of the thyroid hormone or the presence of nodules in the thyroid gland. Fifty-one patients (49 females and 2 males) received operations by gasless, endoscopic trans-axillary approaches with one patient whose operation was converted to open surgery because of internal jugular vein injury. 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/. Background Since Theodor Kocher reduced the mortality rate of thyroidectomy from the 40% reported by Billroth to 0.2% in 1895, a collar incision with open removal of the thyroid gland is the standard procedure [1, 2]. In each patient, the indication for surgery was a small nodule of unclear malignant potential. This study was approved by the Institutional Ethics Committee of Xiangya Hospital, Central South University (No.202011960). In this way, the incision can be planned with the patients input and awareness. Patients who spend the night in the hospital are typically discharged by 10AM the next morning. During the post operative visit, a blood test called TSH level may be checked to measure the levels of thyroid hormone in order to determine if the dose is correct. Lee et al. The sensory change and paralysis results from this technique and patients satisfaction with the cosmesis were also studied. First, we dissected the tunnel to the anterior neck area with exposure of the sternocleidomastoid muscle (SCM). Transoral thyroidectomy. Article Patient concern about cosmetic appearance has led surgeons to explore performing surgery through smaller incisions to extract tumors. 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. All existing creases can be mapped out in order to configure an incisional line that is parallel to a regional crease. The exceptions are blood thinners, aspirin, Plavix, and anti-thyroid medications like PTU and Methimazole. Rarely, nerve injury to the arm can occur, resulting in impaired arm and/or hand function. [aQ Fc8x4*hp4p,9z6iU R GEuKWT4Ci.GvIbu,sg E{miq41hJH|>&G&W The surgeon has excellent magnified visualization, can manipulate the camera to customize the view of the field, and works with surgical instruments that are more maneuverable than the human wrist and hand. . Some people experience a dull ache, while others feel a sharp pain. Springer Nature. They are typically not dangerous unless cancer cells develop in the goitrous thyroid enlargement. The patient is usually given general anesthesia to numb the. qDH z(a;Lq#t further described gasless endoscopic thyroidectomy through the axillary region, which can effectively avoid the influences of carbon dioxide [8]. A comparison of postoperative pain after conventional open thyroidectomy and single-incision, gasless, endoscopic transaxillary thyroidectomy: a single institute prospective study. The most recent trend has been to perform thyroid surgery while avoiding any neck incision at all. No evidence of recurrence was found during the follow-up period. 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. 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. It is usually removed in 1-2 days. For standard-length incisions, a good alternate choice, if a normal symmetrical crease is not available, is a line parallel to a normal skin crease. TR}Iu9!'\2q/ In the first 20 cases, the longest time of working space makes was more than 2 h. However, it is likely that the operative time, including working space makes and thyroidectomy with or without CND, will gradually decrease as we gain more experience. A special retractor is placed to create a space for the surgeon to remove the thyroid gland. Ann Surg Oncol. The addition of robotics can improve surgical dexterity in a difficult-to-reach anatomic region [6]. Conventional open thyroidectomy (COT) is the most commonly used approach for thyroidectomy. Columbia University Irving Medical Center, Department of Surgery, New York, NY. 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 The collodion will turn white and start curling up at the edges in about 5 to 7 days. Most of the time, the surgery can be done this way. Figure 42-4 Examples of the so-called necklace neck incision associated with a classical thyroidectomy through an open approach (A and B). However, thyroidectomy is still difficult because the thyroid gland is rich in blood supply and is adjacent to parathyroid glands and important nerves. The VRSs in a short time (1 week) were significantly higher in the first 25 cases than in the last 25 cases (the patient whose operation was converted to open surgery was excluded). The mean age was 34 years old, ranging from 19 to 45 years. 2013;9:11621. also reported a study concerning the gasless trans-axillary thyroidectomy with the assistance of robots. Johri G, Chand G, Mishra A, Mayilvaganan S, Agarwal G, Agarwal A, et al. The PSSs were 1 (very satisfied), 2 (satisfied), 3 (unsatisfied), or 4 (very unsatisfied) [13]. For example, a gentleman with a 26-inch neck (Figure 42-2. The optimal position in which to mark the anticipated thyroid incision is with the patient seated upright in the holding area. 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. 2009;146:104855. The retractors (Kangji, Hangzhou, China) were used to maintain the working space during the operation. We also recommend a multivitamin for most patients. A number of surgical procedures and surgical approaches have been developed and the terminology can be confusing. Only two patients developed temporary vocal cord paralysis and no patients developed other severe complications. The midline fascia was divided and strap muscles separated from the thyroid gland. A number of important principles are worth considering when planning a thyroidectomy or parathyroidectomy, and these transcend the specific procedure that is anticipated. The time of LT with or without CND was 40.9 15.1 min (range 3090 min). In any case, the incision should be parallel to relaxed skin tension lines, following classic cosmetic principles. The sternal head of the SCM was subsequently retracted to expose the strap muscles. Patients may also be given a prescription for thyroid hormone medication (Levothyroxine or Synthroid). 82073262) and the Hunan Province Natural Science Foundation (grant number 2021JJ41033 and 2019JJ40475). Acceptable wound cosmetology has . If the patient was not taking thyroid hormone prior to the operation, the surgeon may prescribe these tablets following surgery. Remote access is focused by many surgeons in the decade to be a feasible technique in thyroidectomy avoiding the neck scar caused by conventional surgery, which includes endoscopic or robotic approaches [16, 17]. WHERE WILL THE INCISION BE? Classically 8-12 cm (3-5 inch) incisions were performed. When this happens, you can trim the edges or let the glue fall off on its own. Thyroid cancer is an increasingly prevalent malignancy worldwide [1]. 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. Because these structures are intimately associated with the thyroid gland, your calcium levels may be affected either temporarily or permanently after thyroid surgery. 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. 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%. The suit covers the incision and prevents your dog from licking or chewing the incision. The average blood loss was 21.0 26.8 ml (10200 ml). 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. Your incision will be located on the front of your neck. Kim EY, Lee KH, Park YL, Park CH, Lee CR, Jeong JJ, et al. A thyroidectomy is the surgical removal of all (total thyroidectomy) or part (partial thyroidectomy) of your thyroid gland the butterfly-shaped organ in your neck. 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). If the seroma is large, the surgeon may drain it with a small needle. 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. Kang SW, Lee SC, Lee SH, Lee KY, Jeong JJ, Lee YS, et al. J Minim Access Surg. 2005;15:64752. Minimally invasive incisions might be placed in the hollow between the medial heads of the sternocleidomastoid muscle. Substernal goiter can be removed through a relatively straightforward collar incision in the lower neck. Our data indicated that sensory changes around the anterior chest are relieved over time in most cases. Thyroid Nodules Diagnosis and Treatment , Follicular Thyroid Cancer/ Hurthle Cell Carcinoma. During the limited follow-up periods, no recurrence has been found. Fada Xia. During the procedure: Goiters are noncancerous enlargement of the thyroid gland. 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%. This requires a general anaesthetic technique similar to that for thyroid surgery . The Procedure of Traditional Low Collar Incision Thyroidectomy The patient was placed in the supine position neck hyperextension. By using this website, you agree to our (A and B, Redrawn from Lore JM, Medina JE, editors: Atlas of head and neck surgery, Philadelphia, 2005, Elsevier-Saunders.). 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. J Laparoendosc Adv Surg Tech A. Surg Oncol Clin N Am. Endoscopic hemithyroidectomy with prophylactic ipsilateral central neck dissection via an unilateral axillo-breast approach without gas insufflation for unilateral micropapillary thyroid carcinoma: preliminary report. 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. Definition: Thyroidectomy is the surgical removal of all or part of the thyroid gland. Cong, R., Li, X., Ouyang, H. 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. If any of these symptoms happen, the patient should call 911 first and then their surgeon. This surgical procedure is known as athyroidectomy. 3). The MacFee incision (B) respects the relaxed skin tension lines in the neck and is therefore cosmetically superior, but it can be awkward to work through. Kang SW, Jeong JJ, Yun JS, Sung TY, Lee SC, Lee YS, et al. Endocr J. Ann Surg Treat Res. 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. If you experience itching once the collodion is off, you may apply lotion to the scar. 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. All authors made substantive intellectual contributions to this study to qualify as authors. it is possible to perform an open thyroidectomy with an incision of 3.3-4.2cm. The primary advantage of this surgical procedure is avoidance of an incision on the neck. Thus, gasless endoscopic thyroidectomy without the assistance of robots might be more suitable. As the working space is crucial to the surgery and time-consuming, the time of working space makes and thyroidectomy were calculated separately. It has been pointed out by Kang et al. Minimally invasive thyroidectomy is a surgical approach to remove the thyroid gland through smaller incisions. Berber E, Bernet V, Fahey TJ 3rd, Kebebew E, Shaha A, Stack BC Jr, et al. MedicineNet does not provide medical advice, diagnosis or treatment. The mean number of lymph nodes removed by unilateral CND was 3.15 3.2 (range 212) in PTC patients. Eur Arch Otorhinolaryngol. 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]. A This case has been converted to open surgery. It is no longer sufficient to remove a thyroid, preserve the laryngeal nerves, and preserve the parathyroid glands (Figure 42-4). Ryan WR. The neck appearance score was low in all cases (either satisfied or very satisfied). Meanwhile, the postoperative stiffness and paraesthesia of the SCM can also be ameliorated due to the shorter surgical time, and improved surgical techniques. 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. There are two nerves called the recurrent laryngeal nerves that run just behind the thyroid. The medical clearance allows the patient's medical team the opportunity to optimize the patient's health prior to an operation and allow the specialists to make recommendations for how best to care for the patient's other medical issues during the peri-operative period.
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