qDH z(a;Lq#t low collar incision Written informed consent for publication of their clinical details and clinical images was obtained from all patients. 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. 4). WBX and ZYZ edited the manuscript. When present, surgical removal is generally indicated. Lang BH, Chow MP. Over a hundred thousand thyroid surgeries are performed per year in the United States. Gasless, endoscopic trans-axillary thyroid surgery: our series of the 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. WBX and ZYZ drafted the Result, Discussion, and Conclusion sections. 2011;25:161723. Thyroidectomy is the most common endocrine surgical procedure performed throughout the world.1 In the city of . Moreno Llorente P, E AGL, Alberich Prats M, Francos Martnez JM, Garca Barrasa A. Surgical approaches to thyroid. After a total thyroidectomy, patients will need to take thyroid hormone replacement pills (one pill a day for the rest of their lives). The muscles around the thyroid gland are retracted to expose the thyroid gland. Comparison of total endoscopic thyroidectomy with conventional open thyroidectomy for treatment of papillary thyroid cancer: a systematic review and meta-analysis. AN INCISION (CUT) THAT WILL REQUIRE SPECIAL CARE. Surg Endosc. The neck was entered through a collar incision, and bleeding was controlled with electrocautery. Our results revealed the complications rate was relatively low and acceptable (Table 2). 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. The best way to identify the proper crease and overall location is with the patient sitting upright in the preoperative holding area rather than waiting until the patient is lying supine on an operating table (Figure 42-6). Expert thyroid care for adults and children. Chen GZ, Zhang X, Shi WL, Zhuang ZR, Chen X, Han H. Systematic comparison of cervical and extra-cervical surgical approaches for endoscopic thyroidectomy. The midline fascia was divided and strap muscles separated from the thyroid gland. Patients will receive general anesthesia. (A and B, Redrawn from Lore JM, Medina JE, editors: Atlas of head and neck surgery, Philadelphia, 2005, Elsevier-Saunders.). Popular incisions included the Lahey incision (Figure 42-1. n7z0#L1gV>>Z1>~G|s1OG3(dzmJ ')6bF1]/Bpp Surg Oncol Clin N Am. Solved Preop Dx: Cold thyroid nodule Postop Dx: Multinodular - Chegg This approach accesses the thyroid through an incision inside the mouth. Columbia Thyroid Center surgeons perform minimally invasive thyroid surgery in over 95% of patients, typically using an incision measuring just an inch to an inch and a half in length. The two other complications that may occur after thyroid surgery involve two of the structures that are intimately associated with the thyroid gland and that may be affected by surgery, the parathyroid glands and the recurrent laryngeal nerve. Gasless, endoscopic trans-axillary thyroid surgery: our series of the first 51 human cases. Feeling that something is stuck in the throat. C and D, Both the right and the left neck may be thoroughly dissected with appropriate retraction assistance. Thyroidectomy Basics | Epomedicine The dissected area is marked in red. Total thyroidectomy (sometimes called near-total thyroidectomy) is the surgical removal of the entire thyroid gland. 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. The patient may then be placed on thyroid hormone pills. J Laparoendosc Adv Surg Tech A. Thus, the outcome of substernal goiter surgery is usually good. Hoarseness generally improves within the first 3 to 4 weeks after the operation but it may take up to 6 months. Popular incisions included the Lahey incision (Figure 42-1, A), the MacFee incision (Figure 42-1, B), and eventually a hockey stick type of incision (Figure 42-1, C).8 This last approach developed with recognition of the dangers of a trifurcated incision in which the tips of the trifurcation were prone to ischemia and devitalization, sometimes putting the great vessels of the neck at risk. 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. Acceptable wound cosmetology has . [] Thyroidectomy : 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 majority of people will likely be candidates for this procedure. There are two nerves called the recurrent laryngeal nerves that run just behind the thyroid. 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. 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. It is critical to work with a team of thyroid specialists to choose the right operation for each individual patient. Jules Boeckel of Strasbourg introduced the collar incision to thyroid. 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. 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. 32 0 obj <> endobj Goiters may be a result of the over or underproduction of the thyroid hormone or the presence of nodules in the thyroid gland. The first lymph nodes to be involved are generally the paratracheal lymph nodes. Endocr Relat Cancer. further described gasless endoscopic thyroidectomy through the axillary region, which can effectively avoid the influences of carbon dioxide [8]. From July 2020 to March 2021, 51 patients (49 females and 2 males) underwent operations by gasless, endoscopic trans-axillary approaches, with one patient whose operation was converted to open surgery because of internal jugular vein injury. The primary advantage of this surgical procedure is avoidance of an incision on the neck. At the Columbia Thyroid Center, 95% of our patients are able to go home after a 4 hour observation period in the recovery room. Thus, gasless endoscopic thyroidectomy without the assistance of robots might be more suitable. For images of a functional neck dissection, see following images. Cong, R., Li, X., Ouyang, H. et al. Retractor was placed beneath the strap muscles to finish creating the working space (Fig. 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. 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. Temporary or sometimes permanent hypoparathyroidism (low blood calcium levels). Endoscopic minimally invasive thyroidectomy: first clinical - Springer 2016;26:3317. 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. An accessory 5-mm incision was made on the vertical line of the axillary incision (35 cm far away from this incision) for another operating instrument (Fig. 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. 2). The surgical procedure was similar to the methods described by other surgeon groups [11, 12]. Risks of the thyroid surgery include the risks common to all surgeries including risks associated with administration of general anesthesia, bleeding, and infection. The trans-axillary approach (TA) can hardly locate the contralateral thyroid lobe, causing the limitation of TA in bilateral thyroidectomy. Medical records were reviewed retrospectively. A The superior thyroid vessels were individually ligated. A The retractors were used to maintain the working space during the operation. A portion of the enlarged thyroid (if possible) or the entire thyroid gland may need to be removed. Meanwhile, the postoperative stiffness and paraesthesia of the SCM can also be ameliorated due to the shorter surgical time, and improved surgical techniques. 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. In addition, the scar may become pink and hard. These nerve control the vocal cords. 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 The skin and subcutaneous tissues were separated, and subplatysmal . 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 addition to the complications of standard thyroid surgeries listed below, there are several complications specific to this operation. XYL, HOY, WBX, and ZYZ performed the study, collected the data, and contributed to the design of the study. World J Surg Oncol. 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. Acceptable wound cosmetology has become a focus for thyroid surgeons. While the conventional collar incision is widely used, endoscopic thyroidectomy is gradually becoming accepted for thyroid nodule patients with cosmetic needs [2,3,4].Under the premise of oncological effectiveness, endoscopic thyroidectomy can provide a . 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]. Thyroidectomy: What It Is, Complications & Recovery - Cleveland Clinic 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). Continuous variables are presented as the mean SD and the mean (range). 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. 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. 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. 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. 2021;35(7):3540-3546. https://doi.org/10.1007/s00464-020-07814-y. statement and When this happens, you can trim the edges or let the glue fall off on its own. Single-incision, gasless, endoscopic trans-axillary total thyroidectomy: a feasible and oncologic safe surgery in patients with papillary thyroid carcinoma. 82073262) and the Hunan Province Natural Science Foundation (grant number 2021JJ41033 and 2019JJ40475). As the scar heals, it will appear to be part of the crease and thus camouflage it. Liang J, Zhan L, Xuan M, Zhao Q, Chen L, Yan J, Kuang J, Tan J, Qiu W. Thyroidectomy for thyroid cancer via transareola single-site endoscopic approach: results of a case-match study with large-scale population. Bhargav PR, Kumbhar US, Satyam G, Gayathri KB. The patients were either satisfied or very satisfied with the cosmetic effects. 82073262) and the Hunan Province Natural Science Foundation (grant number 2019JJ40475). The dissected area is marked in blue, The procedure of thyroidectomy and central neck dissection (CND). 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. B In this case, the hemorrhage of IJV has been controlled by using Harmlock. 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. Medscape. 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. Kim EY, Lee KH, Park YL, Park CH, Lee CR, Jeong JJ, et al. A more in-depth study of the learning curve of the procedure via the TA approach is urgently needed. The 27-year . (PDF) Incision Length for Standard Thyroidectomy and - ResearchGate OMIT is an open thyroidectomy performed through a short 'collar' incision and does not necessitate special equipment although two assistants are desirable. The primary endpoint was the cosmesis of the collar scar six weeks after surgery assessed using the patient and observer scar assessment scale (POSAS). A questionnaire regarding the sensory changes around the anterior chest, paralysis of the SCM, and satisfaction with cosmesis was used to evaluate the quality of life in enrolled patients. The size of the incision is dictated by surgeon preference and need for adequate exposure to remove the tumor. Incision: A transverse collar incision is usually made 1-2 fingerbreaths above the sternum along the skin crease. Provided by the Springer Nature SharedIt content-sharing initiative. 2016;23:40238. A 5-6 cm transverse collar skin incision was made into the midline of the anterior neck 2 cm above the sternal notch. A number of technological advances such as advanced energy devices for hemostasis. PDF Creative Commons License [CC BY-NC-ND 4.0] 2022 The Author(s 2023 BioMed Central Ltd unless otherwise stated. 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. It provides a good alternative beyond Kang JB, Kim EY, Park YL, Park CH, Yun JS. Endocr J. These symptoms appear between 24 and 48 hours after surgery. Most people will not be able to notice the incision once the redness fades away. As per the largest study done, the rate of sternotomy is less than 5%, the complication rates are acceptable, and the mortality is less than 1%. A popular alternative to cones is a post-op surgical/recovery suit. 2011;25:135863. Some patients experience a "crawling" sensation in the skin, muscle cramps or headaches. have been classified as minimally invasive. Thyroidectomy for substernal usually includes goiters with minimal extension in the thoracic cavity and those that are present in the mediastinum (the area surrounding the chest cavity ). 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. Despite the additional trauma resulting from the flap formation, the application of the trans-axillary approach is of some value in suitable circumstances. Fifty-one patients (42 PTC patients and 9 thyroid adenoma patients) were included in this study. Our data indicated that sensory changes around the anterior chest are relieved over time in most cases. The patients were placed in a supine position while the lesion side limb was extended 90 degrees after general anesthesia. In addition to using very small incisions, our surgeons "hide" the incision in a natural skin crease which acts like camouflage. 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). A P value < 0.05 was considered as statistically significant. 2009;146:104855. Kendall Jenner and Bad Bunny arrive at the Mark Hotel before Met Gala B, C The recurrent laryngeal nerve (RLN) was identified and then traced. 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. hb`````Jg`a`6Tcg@ ~+s\``fy$ S@5@YN@ZA:V^`` HWy6rC+1oxD7`v`Xvz&fq=@&2` &{^j@ 8S The dissected area is marked in green. 202011960). In these cases, the voice will often be better in the mornings and "tire" toward the end of the day. XYL and HOY analyzed the data. Gasless endoscopic thyroidectomy using trans-axillary approach; surgical outcome of 581 patients. 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. Routine level 2b dissection may be recommended only in N1b papillary thyroid carcinoma with three- or four-level lateral lymph node metastasis. Substernal Goiter Surgery. 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 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. A seroma is a collection of fluid under the incision. This technique can be performed on incisions as small as 2.0 cm (0.8 inches), and generally has excellent healing and cosmetic result. 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. In general, patient should be able to eat their normal diet, but most patients prefer softer foods for the first few days. 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. 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]. A special retractor is placed to create a space for the surgeon to remove the thyroid gland. Thyroidectomy for substernal usually includes goiters with minimal extension in the thoracic cavity and those that are present in the mediastinum (the area surrounding the chest cavity). In any case, the incision should be parallel to relaxed skin tension lines, following classic cosmetic principles.10. By using this website, you agree to our Thyroid Surgery | Columbia Surgery The opposite lobe is not removed, and in general the remaining thyroid gland will produce enough thyroid hormone for the body. Definition: Thyroidectomy is the surgical removal of all or part of the thyroid gland. 2021;19:23. Indications: Proven neoplasm (FNAC) Suspected neoplasm Age: Extreme Sex: Male Koh YW, Park JH, Kim JW, Lee SW, Choi EC. PubMed Central Bilateral axillary approach for total thyroidectomy ensures better identification of recurrent laryngeal nerve (RLN) and PTG on both sides. Even in the rare chance of having a permanently hoarse voice, there are things that can be done to improve or fix the voice. Ann Surg Treat Res. In the past decade, efforts were made to reduce incision size and surgical access trauma by the use of endoscopic techniques. Patients may also be given a prescription for thyroid hormone medication (Levothyroxine or Synthroid). Lobe TE, Wright SK, Irish MS. A comparison of surgical outcomes between endoscopic and robotically assisted thyroidectomy: the authors' initial experience. 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. Lee DY, Oh DJ, Kang KR, Kim MS, Oh KH, Baek SK, et al. 2013;22:113. Cookies policy. If you are dealing with a thyroid issue, our team at the Columbia Thyroid Center is here to help. Only gold members can continue reading. While the conventional collar incision is widely used, endoscopic thyroidectomy is gradually becoming accepted for thyroid nodule patients with cosmetic needs [2,3,4]. World J Surg Onc 20, 9 (2022). Second, we divided the area between the sternal and clavicular head of the SCM, up to the annular cartilage and down to the clavicle. Temporarily lowered calcium levels occur in approximately 15-40% of patients, and is treatable with calcium and vitamin D supplementation post-operatively. If a patient has symptoms caused by low blood calcium, the surgeon may prescribe extra calcium and a vitamin D supplement. It is rare for them to appear after 72 hours. This procedure may also be appropriate for small, non-aggressive thyroid carcinomas less than 1cm. In general, patients may resume taking their normal medications the day after the operation. Incisions as small as 1 inch (2.5 cm) can be performed for patients with favorable neck anatomy and small tumors. Columbia University Irving Medical Center, Department of Surgery, New York, NY. Thyroid storm, also called thyrotoxic crisis, is a life-threatening medical emergency caused by very high levels of circulating thyroid hormone. Comparison between 3-dimensional and 2-dimensional endoscopic thyroidectomy for benign and malignant lesions: a meta-analysis. J Minim Access Surg. (PDF) Comparison of Supraclavicular Oblique Incision - ResearchGate This study was reviewed and approved by the Ethics Committee of Xiangya Hospital, Central South University (No. 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. 2013;9:11621. 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.
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collar incision for thyroidectomy