collar incision for thyroidectomy

Minimally invasive thyroid surgery refers to certain types of surgery in which the thyroid is removed through very small incisions using special techniques. If a patient has symptoms caused by low blood calcium, the surgeon may prescribe extra calcium and a vitamin D supplement. 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. This technique can be performed on incisions as small as 2.0 cm (0.8 inches), and generally has excellent healing and cosmetic result. Bhargav PR, Kumbhar US, Satyam G, Gayathri KB. Kim EY, Lee KH, Park YL, Park CH, Lee CR, Jeong JJ, et al. We divided the patients into two groups in surgical order to compare the VRSs regarding paralysis of the SCM. It provides satisfactory cosmetic outcomes compared with conventional transcervical incision. We also recommend a multivitamin for most patients. Traditionally, parathyroidectomy involved a collar incision, bilateral exploration of the neck, identification of all four glands, and removal of the diseased gland or glands. 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. 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. D Thyroid isthmus was dissected. Nine patients had solitary or cystic thyroid adenoma, and thus, lobectomy was performed. 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. 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. The procedure is not indicated for aggressive thyroid cancers, for very large tumors, or tumors with significant inflammation such as severe Hashimotos thyroiditis, Graves disease, or in patients who are significantly obese or have abnormalities of shoulder function. Call (212) 305-0444 for appointments. 32 0 obj <> endobj The average blood loss for this operation is less than a tablespoon and the chance of needing a blood transfusion is extremely rare. It is in this position that patients will be in public situations such as dinner parties and cocktail receptions, and it is in this position the suprasternal notch (the depression created by the medial heads of the sternocleidomastoid muscle) can best be seen. The system also has tremor filtration and scaling of movements to eliminate tremor and allow very fine microsurgical movements if needed. Medscape. All authors have no conflicts of interest or financial ties to disclose. 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. 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%. Comparison of total endoscopic thyroidectomy with conventional open thyroidectomy for treatment of papillary thyroid cancer: a systematic review and meta-analysis. 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 total mean operative time was 141.6 34.4 min (range 95240 min, from anesthetic intubation to leaving the operating room and entering the postanesthetic care unit (PACU)). Please see the Expert Consult website for more discussion of this topic, including Figure 42-1. volume20, Articlenumber:9 (2022) The stiffness and paraesthesia of the SCM resulting from the division of the SCM are also relieved over time. Patients should not be worried about hurting their voice by talking. WBX and ZYZ drafted the Result, Discussion, and Conclusion sections. All rights reserved. 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. Jules Boeckel of Strasbourg introduced the collar incision to thyroid. Jsls. 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. XYL and HOY analyzed the data. Statistical analyses were conducted using the Students t test and one-way ANOVA through the SPSS 23.0 software. 0 Google Scholar. Jiang WJ, Yan PJ, Zhao CL, Si MB, Tian W, Zhang YJ, et al. 2.5cm . PubMed Hoarseness generally improves within the first 3 to 4 weeks after the operation but it may take up to 6 months. The procedure for thyroidectomy and CND was similar to that of other endoscopic and open approaches. Endoscopic hemithyroidectomy with prophylactic ipsilateral central neck dissection via an unilateral axillo-breast approach without gas insufflation for unilateral micropapillary thyroid carcinoma: preliminary report. 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%. Specific procedural considerations are described, and then a concise enumeration of proposed best practices is offered. Compared with conventional approach, it holds the advantages of comparative extensive indications and similar complication rate but achieving a better cosmetic result. Bilateral axillary approach for total thyroidectomy ensures better identification of recurrent laryngeal nerve (RLN) and PTG on both sides. n7z0#L1gV>>Z1>~G|s1OG3(dzmJ ')6bF1]/Bpp In general, patients may resume taking their normal medications the day after the operation. A special retractor is placed to create a space for the surgeon to remove the thyroid gland. A first attempt was replacement of the central . J Laparoendosc Adv Surg Tech A. The most recent trend has been to perform thyroid surgery while avoiding any neck incision at all. Ann Surg Treat Res. 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. Only gold members can continue reading. that the dissected flap width in trans-axillary approach is significantly wider than conventional thyroidectomy, causing greater trauma, and potentially more severe pain [20]. A popular alternative to cones is a post-op surgical/recovery suit. C, D Step two, sternocleidomastoid muscle (SCM) was dissected longitudinally and the sternal head of SCM was elevated by the retractor to expose the strap muscles. This hardening will peak at about 3 weeks and may result in some tightness especially when swallowing or extending your neck. The dissected area is marked in red. There is no clear definition of what minimally invasive means, and surgical incisions as large as 6 cm. Gasless, endoscopic trans-axillary thyroid surgery: our series of the first 51 human cases. 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. 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 addition to classifying the extent of surgical resection, a number of surgical approaches have been described. 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. [aQ Fc8x4*hp4p,9z6iU R GEuKWT4Ci.GvIbu,sg E{miq41hJH|>&G&W 2016;23:694700. Second, we divided the area between the sternal and clavicular head of the SCM, up to the annular cartilage and down to the clavicle. it is possible to perform an open thyroidectomy with an incision of 3.3-4.2cm. 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. UC Irvine Department of Head & Neck Surgery, 101 The City Drive South Pavilion II Orange, CA 92868, UCI Head & Neck UCI - Audiology Department, UC Irvine Health 101 The City Drive South, Orange, CA 92868, Petrous Apex Lesions, Cholesterol Granuloma, Cyst, Cholesteatoma, Radiosurgery (CyberKnife for Skull Base Tumors or Acoustic Neuromas), Acoustic Neuroma Orange County Los Angeles Southern California, Congenital Atresia of the Ear (Non-Development of the Ear Canal), Minimally Invasive Endoscopic Skull Base Surgery, Otosclerosis Orange County, Los Angeles, Southern California, Surgical Treatment of the Tongue and Lower Throat, Independent Medical Evaluation / Workers Compensation. However, thyroidectomy is still difficult because the thyroid gland is rich in blood supply and is adjacent to parathyroid glands and important nerves. Risks of the thyroid surgery include the risks common to all surgeries including risks associated with administration of general anesthesia, bleeding, and infection. In general, patient should be able to eat their normal diet, but most patients prefer softer foods for the first few days. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. OMIT is an open thyroidectomy performed through a short 'collar' incision and does not necessitate special equipment although two assistants are desirable. Manage cookies/Do not sell my data we use in the preference centre. All authors read and approved the final manuscript. 82073262) and the Hunan Province Natural Science Foundation (grant number 2019JJ40475). He was able to demonstrate efficacy and efficiency through a low cervical collar incision that bears his name. The operation generally lasts from 2-3 hours. By contrast, a television commentator with an 11-inch neck (Figure 42-3, A) and a 2-cm follicular neoplasm (Figure 42-3, B) is an ideal candidate for an endoscopic thyroidectomy. 4). further described gasless endoscopic thyroidectomy through the axillary region, which can effectively avoid the influences of carbon dioxide [8]. Next, a vertical cut will be made through the strap-like muscles located just below the skin, and these muscles . 202011960). 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. B, With wide elevation of subplatysmal flaps, all levels of the neck are accessible. The trans-axillary approach (TA) can hardly locate the contralateral thyroid lobe, causing the limitation of TA in bilateral thyroidectomy. 2020;34:1891903. Medication to normalize abnormal thyroid hormone levels may help decrease the size of goiters. 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. statement and Both lobes of the thyroid were noted to be enlarged. If you experience itching once the collodion is off, you may apply lotion to the scar. The total mean operative time of working space make was 44 12.8 min (range 20120 min). 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. Only two patients developed temporary vocal cord paralysis and no patients developed other severe complications. Your incision will be located on the front of your neck. None of the patients developed hypoparathyroidism, esophageal injury, or surgical site infection after the surgery. 2011;25:135863. 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. 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. 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. Article Thyroidectomy incisions have significantly decreased in size since Kocher first popularized his low collar incision in the late 19 th century 4. 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 . If the seroma is large, the surgeon may drain it with a small needle. Substernal goiter can be removed through a relatively straightforward collar incision in the lower neck. have been classified as minimally invasive. 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. It is noteworthy that there is another obvious disadvantage of this technique. Temporary hoarseness usually gets better within a few weeks, but can take up to 6 months to resolve. See additional information. B, C The recurrent laryngeal nerve (RLN) was identified and then traced. If the mass is deep inside the chest, the surgeon makes an incision along the middle of the chest bone. Prophylactic unilateral central compartment lymph node clearance was conducted. 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. Cir Esp (Engl Ed). 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). However, patients will be asked to do no heavy lifting, swimming, or soaking in a bathtub for 1 week after the operation. The primary endpoint was the cosmesis of the collar scar six weeks after surgery assessed using the patient and observer scar assessment scale (POSAS). AN INCISION (CUT) THAT WILL REQUIRE SPECIAL CARE. The collodion will turn white and start curling up at the edges in about 5 to 7 days. Despite the additional trauma resulting from the flap formation, the application of the trans-axillary approach is of some value in suitable circumstances. Many companies make these suits, and they're washable and reusable. If all 4 glands are injured or removed during the operation, the blood calcium levels can become lower than normal called hypocalcemia. For example, a gentleman with a 26-inch neck (Figure 42-2, A) and a large goiter (Figure 42-2, B) is not a good candidate for any type of minimally invasive approach. 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. 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. Terms and Conditions, Endocr J. It is uncommon, but when it occurs after thyroidectomy, it is usually associated with Grave's disease. . Collar incision was made about 2 1/2cm above the inner ends of the clavicle, through the platysmal muscle.. 2.5cm . 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. Patients may also be given a prescription for thyroid hormone medication (Levothyroxine or Synthroid). Koh YW, Park JH, Kim JW, Lee SW, Choi EC. The typical recommendations for pre-operative testing include: In addition, patients may require additional tests in certain situations to help plan the operation. In the past decade, efforts were made to reduce incision size and surgical access trauma by the use of endoscopic techniques. 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 PSSs were 1 (very satisfied), 2 (satisfied), 3 (unsatisfied), or 4 (very unsatisfied) [13]. hb`````Jg`a`6Tcg@ ~+s\``fy$ S@5@YN@ZA:V^`` HWy6rC+1oxD7`v`Xvz&fq=@&2` &{^j@ 8S 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. 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. The Pattern App Ruined My Life, Articles C