Clinical findings and postoperative complications were analyzed. reported the endoscopic trans-axillary technique. Fada Xia. A tube may be left in place to drain fluid and blood. Figure 42-2 This nonobese gentleman who has a 26-inch neck circumference and a large goiter would not be a candidate for any minimally invasive approach. Other risks of thyroid surgery include wound infections and seromas. The complications, including hypoparathyroidism, tracheal injury, esophageal injury, or surgical site infection did not occur. Cookies policy. 4 Technologic VRSs were relatively high at the 1-week and 1-month visits and were significantly decreased at the 3rd-month visit. Berber E, Bernet V, Fahey TJ 3rd, Kebebew E, Shaha A, Stack BC Jr, et al. Incision: A transverse collar incision is usually made 1-2 fingerbreaths above the sternum along the skin crease. In this way, the incision can be planned with the patients input and awareness. Surg Endosc. This approach involves making an incision in the center of your neck to directly access your thyroid gland. Google Scholar. During the 1850s, operations on the thyroid gland were undertaken via longitudinal, oblique, or vertical neck incisions. 2016;26:3317. Jsls. + )&`30^2{[b#nuwUhSr e4vMHCH qOmo.S2:uZN|/L.J. Thus, the outcome of substernal goiter surgery is usually good. With careful preoperative testing and thoughtful consideration of the type of anesthesia, including the type of intubation, preparation for surgery can be optimized. 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. Our results revealed the complications rate was relatively low and acceptable (Table 2). Manage cookies/Do not sell my data we use in the preference centre. Koh YW, Park JH, Kim JW, Lee SW, Choi EC. Classically 8-12 cm (3-5 inch) incisions were performed. Terms of Use. 2016;23:694700. 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. 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 ). The mean age was 34 years old, ranging from 19 to 45 years. In addition, the scar may become pink and hard. Continuous variables are presented as the mean SD and the mean (range). 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. 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. 2021;35(7):3540-3546. https://doi.org/10.1007/s00464-020-07814-y. After a total thyroidectomy, patients will need to take thyroid hormone replacement pills (one pill a day for the rest of their lives). A, An extended low cervical collar incision is used when a lateral neck dissection is indicated. Correspondence to None of the patients developed hypoparathyroidism, esophageal injury, or surgical site infection after the surgery. Most patients (97%) will not notice any change in their voice after the operation. Mitchem JB, Gillanders WE. C and D, Both the right and the left neck may be thoroughly dissected with appropriate retraction assistance. Medication to normalize abnormal thyroid hormone levels may help decrease the size of goiters. This work was supported by the National Natural Science Foundation of China (grant No. What percentage of the human body is water? 2 ). Statistical analyses were conducted using the Students t test and one-way ANOVA through the SPSS 23.0 software. This helps to ensure proper wound healing in the postoperative period. The collodion will turn white and start curling up at the edges in about 5 to 7 days. Duncan et al. Surgery. The risk of having any of these complications depends on the experience of the surgeon. 2010;24:18897. Compared with conventional open surgery, gasless endoscopic trans-axillary thyroid surgery requires the dissection of the anterior neck area and splitting the SCM, which has been described in the endoscopic lateral neck dissection [15]; however, the stiffness and paraesthesia of the SCM have not been evaluated. Temporary hoarseness usually gets better within a few weeks, but can take up to 6 months to resolve. Your incision is covered with a protective strip of clear glue called collodion. See additional information. Please see the Expert Consult website for more discussion of this topic, including Figures 42-2, 42-3, 42-4, and 42-5. J Laparoendosc Adv Surg Tech A. Gasless single incision trans-axillary thyroidectomy: the feasibility and safety of a hypo-morbid endoscopic thyroidectomy technique. 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. 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. Some people experience a dull ache, while others feel a sharp pain. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. Our data indicated that sensory changes around the anterior chest are relieved over time in most cases. Surgery is typically recommended for goiters that are causing symptoms. Comparison of total endoscopic thyroidectomy with conventional open thyroidectomy for treatment of papillary thyroid cancer: a systematic review and meta-analysis. Gasless endoscopic thyroidectomy using trans-axillary approach; surgical outcome of 581 patients. In the hands of an experienced thyroid surgeon, thyroid surgery is a safe procedure with few complications. In this operation, an incision is made in the axilla (armpit) and dissection is carried superiorly across the collar bone into the neck. Written informed consent for publication of their clinical details and clinical images was obtained from all patients. Bilateral axillary approach for total thyroidectomy ensures better identification of recurrent laryngeal nerve (RLN) and PTG on both sides. The size of the incision is dictated by surgeon preference and need for adequate exposure to remove the tumor. 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. Rarely, a patient may have temporary changes in the voice such as fluctuations in volume and clarity (hoarseness). . Collar incision was made about 2 1/2cm above the inner ends of the clavicle, through the platysmal muscle.. 2.5cm . The patient may be positioned with special pillows under the neck to tilt the head back. Johri G, Chand G, Mishra A, Mayilvaganan S, Agarwal G, Agarwal A, et al. Jules Boeckel of Strasbourg introduced the collar incision to thyroid. Retractor was placed beneath the strap muscles to finish creating the working space (Fig. 2006;10:20611. It provides a good alternative beyond 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 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. Because these structures are intimately associated with the thyroid gland, your calcium levels may be affected either temporarily or permanently after thyroid 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]. 4 Also emerging are techniques for remote access thyroid and 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. Part of They are typically not dangerous unless cancer cells develop in the goitrous thyroid enlargement. It is important to note that numbness and tingling may be caused by something other than a parathyroid problem. Have certain genes or a family member with goiters. It is usually removed in 1-2 days. Call (212) 305-0444 for appointments. However, it also leads to greater trauma [22]. In our study, only two cases had temporary vocal cord paralysis. 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. TR}Iu9!'\2q/ 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. 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. Minimally invasive thyroid surgery refers to certain types of surgery in which the thyroid is removed through very small incisions using special techniques. This test is used in patients with hoarseness, a previous neck operation, or cases of advanced cancer. 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. 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 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. He was able to demonstrate efficacy and efficiency through a low cervical collar incision that bears his name. PubMedGoogle Scholar. 32 0 obj <> endobj that the dissected flap width in trans-axillary approach is significantly wider than conventional thyroidectomy, causing greater trauma, and potentially more severe pain [20]. In the UK, thyroidectomy is not routinely performed under regional anaesthesia. Surg Oncol Clin N Am. Standard incisions that are placed too low, spanning this indented suprasternal notch region, may appear asymmetrical and tend to be hypertrophic in their midsegment as opposed to incisions higher, in a more uniform, cylindrical region of the neck. 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. 2020;34:1891903. In the other case, the hemorrhage of IJV has been controlled by using Harmlock clips (Fig.
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