The final pathology is ready approximately1 week after the operation. Thyroid nodules and cancer management guidelines: comparisons and controversies. 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. Kang JB, Kim EY, Park YL, Park CH, Yun JS. Feeling that something is stuck in the throat. 2005;15:64752. 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. First, we dissected the tunnel to the anterior neck area with exposure of the sternocleidomastoid muscle (SCM). Patients with other significant medical issues may be asked to visit with their medical team to obtain a letter of medical clearance. 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. Last, the strap muscles were dissected laterally, the omohyoid muscle and internal jugular vein (IJV) were also exposed. Endoscopic and robotic thyroidectomy for cancer. 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. 82073262) and the Hunan Province Natural Science Foundation (grant number 2021JJ41033 and 2019JJ40475). Opening of the chest in the surgical management of substernal goiter is rarely required. Goiters may be a result of the over or underproduction of the thyroid hormone or the presence of nodules in the thyroid gland. It is rare for them to appear after 72 hours. VRSs were relatively high at the 1-week and 1-month visits and were significantly decreased at the 3rd-month visit. [aQ Fc8x4*hp4p,9z6iU R GEuKWT4Ci.GvIbu,sg E{miq41hJH|>&G&W Next, a vertical cut will be made through the strap-like muscles located just below the skin, and these muscles . When this happens, you can trim the edges or let the glue fall off on its own. hXms8+/3@6]H1|p@/IBd`zc[Vx}iJL8t3\bDgX&#&'8N,0f2Pq6PbYD\f(6uiMlJt]#aZal14t FlJNlCO} After a total thyroidectomy, patients will need to take thyroid hormone replacement pills (one pill a day for the rest of their lives). a skin incision was made using scalpel, A number of important principles are worth considering when planning a thyroidectomy or parathyroidectomy, and these transcend the specific procedure that is anticipated. MedicineNet does not provide medical advice, diagnosis or treatment. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. All rights reserved. World Journal of Surgical Oncology 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. The location of the tumor was right, n= 30; left, n= 21. In the past decade, advancements in A c c e p t e d . [] Thyroidectomy : Rarely, a surgeon may open the sternum (chest) to remove the goiter. Most people take at least 15-30 days to recover. Fortunately, in the hands of Columbia Thyroid Center surgeons, the risk of bleeding is less than 1%. 4 Also emerging are techniques for remote access thyroid and When the goiter is caused by a noncancerous. If there is no sign of bleeding and the patient feels well, he or she may go home. 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. Thyroidectomy without Ligatures in Differentiated Thyroid Cancer Meanwhile, the postoperative stiffness and paraesthesia of the SCM can also be ameliorated due to the shorter surgical time, and improved surgical techniques. qDH z(a;Lq#t XYL and HOY drafted the Methods sections. Substernal goiter can be removed through a relatively straightforward collar incision in the lower neck. Ryan WR. Frontiers | Comparison of Supraclavicular Oblique Incision With The median hospital stay was 1.67 0.74 (range 13) days. J Minim Access Surg. Patients who spend the night in the hospital are typically discharged by 10AM the next morning. Comparison of total endoscopic thyroidectomy with conventional open thyroidectomy for treatment of papillary thyroid cancer: a systematic review and meta-analysis. 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. MIVAT combines the small incision with use of endoscopes to help provide illumination and visualization of the tumor. 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. Prophylactic unilateral lymphadenectomy was also routinely performed among patients with thyroid cancer including the prelaryngeal, pretracheal, and ipsilateral paratracheal areas (Fig. 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. 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). Thyroidectomy is the most common endocrine surgical procedure performed throughout the world.1 In the city of . Acceptable wound cosmetology has . 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). Patients will receive general anesthesia. 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. All cases of this complication reported to date have been temporarily, and is related to compression of the brachial plexus from arm positioning during surgery. After showering, pat the incision dry. volume20, Articlenumber:9 (2022) WHERE WILL THE INCISION BE? In addition to classifying the extent of surgical resection, a number of surgical approaches have been described. Seromas happen rarely and usually disappear within a few weeks. Figure 42-4 Examples of the so-called necklace neck incision associated with a classical thyroidectomy through an open approach (A and B). This work was supported by the National Natural Science Foundation of China (grant No. 2011;25:161723. Our study suggested that the lateral supraclavicular incision is a safe and practical approach for thyroidectomy. With careful preoperative testing and thoughtful consideration of the type of anesthesia, including the type of intubation, preparation for surgery can be optimized. In the past decade, efforts were made to reduce incision size and surgical access trauma by the use of endoscopic techniques. 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. Thyroidectomy : World J Surg Oncol. 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. Gasless, endoscopic trans-axillary thyroid surgery: our series of the first 51 human cases. Anaesthesia for thyroid and parathyroid surgery | BJA Education This study was reviewed and approved by the Ethics Committee of Xiangya Hospital, Central South University (No. 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. Terms and Conditions, The skin and subcutaneous tissues were separated, and subplatysmal . They will be monitored closely as they need to recover from the anesthesia. The sternal head of the SCM was subsequently retracted to expose the strap muscles. However, patients will be asked to do no heavy lifting, swimming, or soaking in a bathtub for 1 week after the operation. COT allows good direct exposure for both thyroid lobes and central neck compartment. Most people will not be able to notice the incision once the redness fades away. 2017;24:R1326. Aside from fine needle or core needle aspiration of the thyroid gland, the minimal operation for management of the thyroid is hemithyroidectomy, or thyroid lobectomy. Please see the Expert Consult website for more discussion of this topic. A number of surgical procedures and surgical approaches have been developed and the terminology can be confusing. The dose of thyroid hormone is usually based on the person's weight. 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. 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. PDF Care of the Surgical Incision - American Thyroid Association Robotic thyroid surgery using a gasless, transaxillary approach and the da Vinci S system: the operative outcomes of 338 consecutive patients. Call (212) 305-0444 for appointments. 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. Thyroidectomy: What It Is, Complications & Recovery - Cleveland Clinic This is the result of the blood calcium level dropping below normal (hypocalcemia) and is usually temporary. World J Surg Onc 20, 9 (2022). + )&`30^2{[b#nuwUhSr e4vMHCH qOmo.S2:uZN|/L.J. 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. Medical records were reviewed retrospectively. The average blood loss was 21.0 26.8 ml (10200 ml). The primary advantage of this surgical procedure is avoidance of an incision on the neck. Objective: To verify the effectiveness and cosmetic results of thyroidectomy through a lateral supraclavicular incision. 2012;42:83541. There are two nerves called the recurrent laryngeal nerves that run just behind the thyroid. (PDF) Comparison of Supraclavicular Oblique Incision - ResearchGate We also recommend a multivitamin for most patients. Thyroid storm, also called thyrotoxic crisis, is a life-threatening medical emergency caused by very high levels of circulating thyroid hormone. 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. Temporary hoarseness usually gets better within a few weeks, but can take up to 6 months to resolve. 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. Lee et al. After the seventh day, reduce the calcium to one Tums Ultra 1000 tablet three times a day until your follow-up appointment. Department of General Surgery, Xiangya Hospital, Central South University, No. 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. &P3J&lwT,Y+noVac?GEbd1ygA( 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. C and D, Both the right and the left neck may be thoroughly dissected with appropriate retraction assistance. Acceptable wound cosmetology has . It is no longer sufficient to remove a thyroid, preserve the laryngeal nerves, and preserve the parathyroid glands (Figure 42-4). 2021;99:26775. This approach involves making an incision in the center of your neck to directly access your thyroid gland. 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. 2010;24:18897. 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%. 2013;22:113. Jsls. 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]. also reported a study concerning the gasless trans-axillary thyroidectomy with the assistance of robots. 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. 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. He was able to demonstrate efficacy and efficiency through a low cervical collar incision that bears his name. In about 5% of patients who have thyroid surgery, the parathyroid glands do not function properly immediately after thyroid surgery. This can also happen after parathyroid surgery. It is often possible for your surgeon to place the incision in an existing skin crease. . Collar incision was made about 2 1/2cm above the inner ends of the clavicle, through the platysmal muscle.. 2.5cm . Dog Cone Alternatives For Post Op - Whole Dog Journal It provides a good alternative beyond World J Surg. Huang Z, Qin H, Liao J, Meng L, Qin Y, Li B, et al. Article 79 0 obj <>stream Have certain genes or a family member with goiters. You might notice bruising around your incision or upper chest and slight swelling above the scar when you are upright. D Thyroid isthmus was dissected. 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 Comparison between 3-dimensional and 2-dimensional endoscopic thyroidectomy for benign and malignant lesions: a meta-analysis. WBX and ZYZ drafted the Result, Discussion, and Conclusion sections. 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. Jantharapattana K, Maethasith J. Transaxillary gasless endoscopic thyroidectomy versus conventional open thyroidectomy: a randomized study. If the seroma is large, the surgeon may drain it with a small needle. ZYZ modified the design of the study. This study was approved by the Institutional Ethics Committee of Xiangya Hospital, Central South University (No.202011960). A 4-cm length incision was made just behind the anterior axillary fold for the laparoscope (a rigid 30-degree videoscope) and one operating instrument. Kang SW, Lee SC, Lee SH, Lee KY, Jeong JJ, Lee YS, et al. Cir Esp (Engl Ed). In any case, the incision should be parallel to relaxed skin tension lines, following classic cosmetic principles. 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. Popular incisions included the Lahey incision (Figure 42-1. It is prudent to resect a sliver of skin edge on either or both sides of the incision (B), which leads to a more predictable healing result and minimizes the risk of hypertrophic scarring. However, thyroidectomy is still difficult because the thyroid gland is rich in blood supply and is adjacent to parathyroid glands and important nerves. Surg Endosc. Skin flaps were created deep to the platysma up to the hyoid bone and down to the suprastemal notch. Berber E, Bernet V, Fahey TJ 3rd, Kebebew E, Shaha A, Stack BC Jr, et al. Because these structures are intimately associated with the thyroid gland, your calcium levels may be affected either temporarily or permanently after thyroid surgery. No evidence of recurrence was found during the follow-up period. However, in the first 24 to 48 hours, patients and their family/friends should observe the incision and neck for signs of bleeding in the neck 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. 2021; https://doi.org/10.1007/s00464-021-08424-y. Please see the Expert Consult website for more discussion of this topic, including Figures 42-2, 42-3, 42-4, and 42-5. Endoscopic thyroidectomy. Compared with conventional approach, it holds the advantages of comparative extensive indications and similar complication rate but achieving a better cosmetic result. For persons with pre-existing shoulder abnormalities, these could be exacerbated by surgery. Thyroid Surgery Recovery, Side Effects, and Complications - Verywell Health 1). This technique can be performed on incisions as small as 2.0 cm (0.8 inches), and generally has excellent healing and cosmetic result. 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. 0 Acceptable wound cosmetology has become a focus for thyroid surgeons. As the working space is crucial to the surgery and time-consuming, the time of working space makes and thyroidectomy were calculated separately. Transaxillary robotic thyroid lobectomy and transaxillary robotic thyroidectomy were developed in Korea, and over the last several years has been utilized by a small but growing number of surgeons. This will disappear over the next 3 to 6 months. 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. The dissected area is marked in green. The time of LT with or without CND was 40.9 15.1 min (range 3090 min). 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. Transoral thyroidectomy. The risk of a substernal goiter is higher in people who: 1996-2023 MedicineNet, Inc. An Internet Brands company. Endocr J. The neck appearance score was low in all cases (either satisfied or very satisfied). hbbd``b`$M .$A "H$&X@2`b AzU R\bitiL #3=|` h However, the risk of damage to this nerve must be understood prior to surgery. A 5-6 cm transverse collar skin incision was made into the midline of the anterior neck 2 cm above the sternal notch. 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. A This case has been converted to open surgery. 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%. Thyroid cancer often spreads to lymph nodes in the neck. 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. 202011960). Ann Surg Oncol. Privacy 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. The midline fascia was divided and strap muscles separated from the thyroid gland. As the scar heals, it will appear to be part of the crease and thus camouflage it. Surg Endosc. However, depending on the presence of any visible skin crease, a higher incision at the cricoid level along the visible skin crease is sometimes preferred to enhance the cosmetic outcome (Fig. 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. 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. Is Substernal Goiter Surgery Safe? - MedicineNet 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. Novel uses of surgical robotics in head and neck 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. Single-incision, gasless, endoscopic trans-axillary total thyroidectomy: a feasible and oncologic safe surgery in patients with papillary thyroid carcinoma. 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. The typical recommendations for pre-operative testing include: In addition, patients may require additional tests in certain situations to help plan the operation. 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. Meanwhile, prospective clinical studies are needed to investigate and validate surgical and oncological outcomes. After a completion thyroidectomy, patients will need to take thyroid hormone replacement pills (one pill a day for the rest of their lives). Duncan et al. Retractor was placed beneath the strap muscles to finish creating the working space (Fig. The traditional "Kocher incision", an 8-10 cm collar incision, is regarded as the conventional appropriate incision for thyroidectomy.2 However, many new approaches for thyroid surgery were developed in order to further minimize the size of the surgical incision.3 Post-thyroidectomy scars have a negative effect on quality of life. Cite this article. Provided by the Springer Nature SharedIt content-sharing initiative. Rong Cong and Xinying Li contributed equally to this work. The neck was entered through a collar incision, and bleeding was controlled with electrocautery. 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 . However, the rate of complications is higher in individuals older than 60 years of age. A number of technological advances such as advanced energy devices for hemostasis. Ann Surg Oncol. 2021;19:23. All authors made substantive intellectual contributions to this study to qualify as authors. Written informed consent for publication of their clinical details and clinical images was obtained from all patients. 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. During the procedure: Goiters are noncancerous enlargement of the thyroid gland. that the dissected flap width in trans-axillary approach is significantly wider than conventional thyroidectomy, causing greater trauma, and potentially more severe pain [20]. Parathyroidectomy 2.5cm . It is important to note that numbness and tingling may be caused by something other than a parathyroid problem. A "thyroidectomy" should not be confused with a "thyroidotomy" ("thyrotomy"), which is a cutting into the thyroid, to get access for a median laryngotomy, or to perform a biopsy. 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, The size of the incision is dictated by surgeon preference and need for adequate exposure to remove the tumor. . The most recent trend has been to perform thyroid surgery while avoiding any neck incision at all. Your incision will be located on the front of your neck.
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