Gasless endoscopic thyroidectomy using trans-axillary approach; surgical outcome of 581 patients. A completion thyroidectomy is usually done after a thyroid lobectomy reveals cancer in the first half of the thyroid but may also be done for multinodular goiter or hyperthyroidism. However, thyroidectomy is still difficult because the thyroid gland is rich in blood supply and is adjacent to parathyroid glands and important nerves. WBX and ZYZ edited the manuscript. They have a higher death rate due to postoperative complications. Minimally invasive thyroid surgery refers to certain types of surgery in which the thyroid is removed through very small incisions using special techniques. Surgery. Only two patients developed temporary vocal cord paralysis and no patient developed permanent vocal cord paralysis. This is the result of the blood calcium level dropping below normal (hypocalcemia) and is usually temporary. Expert thyroid care for adults and children. TR}Iu9!'\2q/ If you experience itching once the collodion is off, you may apply lotion to the scar. However, the risk of damage to this nerve must be understood prior to surgery. Surg Endosc. reported the endoscopic trans-axillary technique. The collodion will turn white and start curling up at the edges in about 5 to 7 days. The middle thyroid vein was then ligated. 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). Jantharapattana K, Maethasith J. Transaxillary gasless endoscopic thyroidectomy versus conventional open thyroidectomy: a randomized study. Terms and Conditions, Incisions as small as 1 inch (2.5 cm) can be performed for patients with favorable neck anatomy and small tumors. The thyroidectomy (near or total), as we know it today, began in the 1860s with the help of Billroth [ 5 ]. 1). Objective: To verify the effectiveness and cosmetic results of thyroidectomy through a lateral supraclavicular incision. All authors have agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. This helps to ensure proper wound healing in the postoperative period. This study kept the confidentiality of patient data and strictly complied with the Declaration of Helsinki and its later amendments or comparable ethical standards. As the working space is crucial to the surgery and time-consuming, the time of working space makes and thyroidectomy were calculated separately. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. 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. Patients should discuss with their doctors when and if they should restart these medications. Correspondence to + )&`30^2{[b#nuwUhSr e4vMHCH qOmo.S2:uZN|/L.J. 79 0 obj <>stream Duncan TD, Ejeh IA, Speights F, Rashid QN, Ideis M. Endoscopic transaxillary near total thyroidectomy. COVID-19 News: Vaccine Info | In Person Visits | Virtual Visits. 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. Figure 42-6 The optimal position in which to mark the anticipated thyroid incision is with the patient seated upright in the holding area. Patients who spend the night in the hospital are typically discharged by 10AM the next morning. A The retractors were used to maintain the working space during the operation. This will disappear over the next 3 to 6 months. AN INCISION (CUT) THAT WILL REQUIRE SPECIAL CARE. Next, a vertical cut will be made through the strap-like muscles located just below the skin, and these muscles . Thyroid cancer often spreads to lymph nodes in the neck. The parathyroid glands control calcium homeostasis within the body. Medscape. 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. The opposite lobe is not removed, and in general the remaining thyroid gland will produce enough thyroid hormone for the body. World J Surg. Thus, gasless endoscopic thyroidectomy without the assistance of robots might be more suitable. The system also has tremor filtration and scaling of movements to eliminate tremor and allow very fine microsurgical movements if needed. This study was reviewed and approved by the Ethics Committee of Xiangya Hospital, Central South University (No. Endoscopic hemithyroidectomy with prophylactic ipsilateral central neck dissection via an unilateral axillo-breast approach without gas insufflation for unilateral micropapillary thyroid carcinoma: preliminary report. 2005;15:64752. 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. You can shower and wash your hair as usual, but do not soak or scrub the incision. 3). 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. World J Surg Oncol. Thus, the outcome of substernal goiter surgery is usually good. For persons with pre-existing shoulder abnormalities, these could be exacerbated by surgery. Figure 42-1 The Lahey incision (A) affords wide access to the lateral neck, but it is associated with a trifurcation, which is subject to necrosis. See additional information. A number of surgical procedures and surgical approaches have been developed and the terminology can be confusing. 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). The nodes may be referred to as level 6 lymph nodes based on the AJCC staging criteria. The neck appearance score was low in all cases (either satisfied or very satisfied). The sternal head of the SCM was subsequently retracted to expose the strap muscles. 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. 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. The suit covers the incision and prevents your dog from licking or chewing the incision. In addition to the complications of standard thyroid surgeries listed below, there are several complications specific to this operation. This test is used in patients with hoarseness, a previous neck operation, or cases of advanced cancer. 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 . Cir Esp (Engl Ed). In any case, the incision should be parallel to relaxed skin tension lines, following classic cosmetic principles.10. https://doi.org/10.1186/s12957-021-02484-z, DOI: https://doi.org/10.1186/s12957-021-02484-z. Kim SK, Park I, Hur N, Lee JH, Choe JH, Kim JH, et al. 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. Continuous variables are presented as the mean SD and the mean (range). The vast majority of patients do not require narcotic pain medications. 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. that the dissected flap width in trans-axillary approach is significantly wider than conventional thyroidectomy, causing greater trauma, and potentially more severe pain [20]. 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. There are a number of factors that affect suitability for this procedure. Surg Endosc. 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. If there is no sign of bleeding and the patient feels well, he or she may go home. Preoperative fine-needle aspiration cytology (FNAC) suggested malignancy in 42 patients, where lobectomy and prophylactic unilateral central neck dissection were performed. Most patients (97%) will not notice any change in their voice after the operation. Modern thyroid surgery found its origins in the late 19th century in the work of Billroth and Kocher. Modern thyroid surgery found its origins in the late 19th century in the work of Billroth and Kocher.7 Although Billroth is credited with first systematically pursuing thyroidectomy in a deliberate fashion, it was Kocher who developed a safe and reproducible technique for accomplishing a therapeutic thyroidectomy. Incomplete removal of the thyroid and complications in preserving all the critical structures beneath and around the thyroid gland are frequent events among inexperienced and occasional thyroid surgeons. 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. The dissected area is marked in green. The best suits have snaps in the areas of the penis or vulva and the anus so you don't have to take the suit off when . Compared with conventional approach, it holds the advantages of comparative extensive indications and similar complication rate but achieving a better cosmetic result. Please see the Expert Consult website for more discussion of this topic, including Figure 42-1. The most recent trend has been to perform thyroid surgery while avoiding any neck incision at all. Privacy Thyroid cancer is an increasingly prevalent malignancy worldwide [1]. The dissected area is marked in blue, The procedure of thyroidectomy and central neck dissection (CND). 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. 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. 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. This approach involves making an incision in the center of your neck to directly access your thyroid gland. ZYZ modified the design of the study. 2). 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. 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. Mitchem JB, Gillanders WE. The total mean operative time of working space make was 44 12.8 min (range 20120 min). hb`````Jg`a`6Tcg@ ~+s\``fy$ S@5@YN@ZA:V^`` HWy6rC+1oxD7`v`Xvz&fq=@&2` &{^j@ 8S As the working space is crucial to the surgery, we have summarized this process in three standard steps. 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. As the scar heals, it will appear to be part of the crease and thus camouflage it. It is no longer sufficient to remove a thyroid, preserve the laryngeal nerves, and preserve the parathyroid glands (Figure 42-4). A special retractor is placed to create a space for the surgeon to remove the thyroid gland. The location of the tumor was right, n= 30; left, n= 21. 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. 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. It is uncommon, but when it occurs after thyroidectomy, it is usually associated with Grave's disease. MedicineNet does not provide medical advice, diagnosis or treatment. 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. Surgery is typically recommended for goiters that are causing symptoms. The patient may then be placed on thyroid hormone pills. No internal jugular vein injury was reported [19]. The trans-axillary approach (TA) can hardly locate the contralateral thyroid lobe, causing the limitation of TA in bilateral thyroidectomy. The skin and subcutaneous tissues were separated, and subplatysmal . A portion of the enlarged thyroid (if possible) or the entire thyroid gland may need to be removed. Acceptable wound cosmetology has . 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).