Collar incision was made about 2 1/2cm above the inner ends of the clavicle, through the platysmal muscle. The retractors (Kangji, Hangzhou, China) were used to maintain the working space during the operation. 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. E, F Step three, the strap muscles were dissected laterally and the retractor was placed beneath the straps muscle to expose the thyroid lobe. Under the premise of oncological effectiveness, endoscopic thyroidectomy can provide a safe option for these patients [5]. All rights reserved. The skin and subcutaneous tissues were separated, and subplatysmal . A seroma is a collection of fluid under the incision. 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. Objective: To verify the effectiveness and cosmetic results of thyroidectomy through a lateral supraclavicular incision. 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. Examples of the so-called necklace neck incision associated with a classical thyroidectomy through an open approach (, Delivery of a thyroid lobe through a minimal access incision. XYL and HOY analyzed the data. 3). In our study, only two cases had temporary vocal cord paralysis. Rarely, nerve injury to the arm can occur, resulting in impaired arm and/or hand function. With careful preoperative testing and thoughtful consideration of the type of anesthesia, including the type of intubation, preparation for surgery can be optimized. 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. 2). Permanent nerve damage occurs in approximately 1% of cases performed by a skilled surgeon. Your incision is covered with a protective strip of clear glue called collodion. low collar incision 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. Only two patients developed temporary vocal cord paralysis and no patients developed other severe complications. A P value < 0.05 was considered as statistically significant. Ann Surg Oncol. Nabhan F, Ringel MD. In the hands of an experienced thyroid surgeon, thyroid surgery is a safe procedure with few complications. 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. We have been using this approach since 1999. Please see the Expert Consult website for more discussion of this topic, including Figures 42-2, 42-3, 42-4, and 42-5. Ryan WR. No evidence of recurrence was found during the follow-up period. 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. The procedure for thyroidectomy and CND was similar to that of other endoscopic and open approaches. This study was approved by the Institutional Ethics Committee of Xiangya Hospital, Central South University (No.202011960). further described gasless endoscopic thyroidectomy through the axillary region, which can effectively avoid the influences of carbon dioxide [8]. It is no longer sufficient to remove a thyroid, preserve the laryngeal nerves, and preserve the parathyroid glands (Figure 42-4). Chapter 42 Incisions in Thyroid and Parathyroid Surgery. In this way, the incision can be planned with the patients input and awareness. 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. 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. Furthermore, the sensory change and paralysis results from this technique and patients satisfaction with the cosmesis were also studied. 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. The nodes may be referred to as level 6 lymph nodes based on the AJCC staging criteria. Rong Cong and Xinying Li contributed equally to this work. The rate of permanently low calcium levels after a total thyroidectomy is anywhere from 1-5%. If the seroma is large, the surgeon may drain it with a small needle. 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. The patient is usually given general anesthesia to numb the. Second, we divided the area between the sternal and clavicular head of the SCM, up to the annular cartilage and down to the clavicle. 2021;19:23. It is important to note that numbness and tingling may be caused by something other than a parathyroid problem. The Procedure of Traditional Low Collar Incision Thyroidectomy The patient was placed in the supine position neck hyperextension. Several reports with large case cohorts were regarding robotically assisted thyroidectomy [8,9,10]. This consists of removal of one lobe of the thyroid gland, and the isthmus of the gland. Eur Arch Otorhinolaryngol. The mean number of lymph nodes removed by unilateral CND was 3.15 3.2 (range 212) in PTC patients. 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. 2009;56:3619. Thyroid. Patient concern about cosmetic appearance has led surgeons to explore performing surgery through smaller incisions to extract tumors. 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. This technique can be performed on incisions as small as 2.0 cm (0.8 inches), and generally has excellent healing and cosmetic result. 2016;23:694700. For persons with pre-existing shoulder abnormalities, these could be exacerbated by surgery. 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. In this study, 51 patients accepted gasless, endoscopic trans-axillary thyroid surgery with only one patient whose operation was converted to open surgery. The cosmetic effect and the self-healing of the discomfort in the anterior neck area and SCM suggest that the application of gasless endoscopic trans-axillary thyroidectomy is feasible. During the limited follow-up periods, no recurrence has been found. The primary endpoint was the cosmesis of the collar scar six weeks after surgery assessed using the patient and observer scar assessment scale (POSAS). n7z0#L1gV>>Z1>~G|s1OG3(dzmJ ')6bF1]/Bpp Surg Endosc. Classically 8-12 cm (3-5 inch) incisions were performed. Perhaps the most important element in optimizing access while maintaining good cosmesis is choosing the proper location for an incision. Clinical findings and postoperative complications were analyzed. A comparison of surgical outcomes between endoscopic and robotically assisted thyroidectomy: the authors' initial experience. Later on, in 1880, Jules Boeckel of Strasbourg introduced the collar incision to thyroid surgery, and this approach was popularized, later on, by Theodor Kocher. Patients should not be worried about hurting their voice by talking. Minimally invasive incisions might be placed in the hollow between the medial heads of the sternocleidomastoid muscle. The average blood loss was 21.0 26.8 ml (10200 ml). Meanwhile, prospective clinical studies are needed to investigate and validate surgical and oncological outcomes. 4 Technologic Call (212) 305-0444 or request an appointment online. 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. The first lymph nodes to be involved are generally the paratracheal lymph nodes. Great efforts are made during surgery to identify and preserve this nerve on both side of the thyroid gland. A The superior thyroid vessels were individually ligated. Thus, the outcome of substernal goiter surgery is usually good. ZYZ modified the design of the study. World J Surg Onc 20, 9 (2022). Nine patients had solitary or cystic thyroid adenoma, and thus, lobectomy was performed. 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 All existing creases can be mapped out in order to configure an incisional line that is parallel to a regional crease. FDX conceived of the design of the study. Lee DY, Oh DJ, Kang KR, Kim MS, Oh KH, Baek SK, et al. While the conventional collar incision is widely used, endoscopic thyroidectomy is gradually becoming accepted for thyroid nodule patients with cosmetic needs [2,3,4]. The sternal head of the SCM was subsequently retracted to expose the strap muscles. In cases of indeterminate lesions, some surgeons refer to a thyroid lobectomy as a diagnostic lobectomy because the main purpose of the operation is to make a diagnosis cancer or benign thyroid disease. The sensory change and paralysis results from this technique and patients satisfaction with the cosmesis were also studied. Kang SW, Lee SC, Lee SH, Lee KY, Jeong JJ, Lee YS, et al. They have a higher death rate due to postoperative complications. 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. 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. Most patients (97%) will not notice any change in their voice after the operation. The location of the tumor was right, n= 30; left, n= 21. Surg Oncol Clin N Am. Compared with conventional approach, it holds the advantages of comparative extensive indications and similar complication rate but achieving a better cosmetic result. It provides satisfactory cosmetic outcomes compared with conventional transcervical incision. The primary advantage of this surgical procedure is avoidance of an incision on the neck. 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. However, COT normally requires a long collar incision (usually 5-8 cm in length) on the anterior neck [1]. The total mean operative time of working space make was 44 12.8 min (range 20120 min). Although the risk of these complications cannot be eliminated entirely, they can be minimized in the hands of an experienced thyroid surgeon. In this operation, an incision is made in the axilla (armpit) and dissection is carried superiorly across the collar bone into the neck. 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). This is the result of the blood calcium level dropping below normal (hypocalcemia) and is usually temporary. There are two nerves called the recurrent laryngeal nerves that run just behind the thyroid. 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). The risk of having any of these complications depends on the experience of the surgeon. In the UK, thyroidectomy is not routinely performed under regional anaesthesia. Patients should call their surgeon's office to make a follow up appointment 3 weeks after surgery. Robotic thyroid surgery using a gasless, transaxillary approach and the da Vinci S system: the operative outcomes of 338 consecutive patients. 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. Only gold members can continue reading. American Thyroid Association Statement on Remote-Access Thyroid Surgery. 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. Have certain genes or a family member with goiters. If any of these symptoms happen, the patient should call 911 first and then their surgeon. Patients should discuss with their doctors when and if they should restart these medications. Routine level 2b dissection may be recommended only in N1b papillary thyroid carcinoma with three- or four-level lateral lymph node metastasis. The majority of people will likely be candidates for this procedure. In addition to the complications of standard thyroid surgeries listed below, there are several complications specific to this operation. 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. 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. 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. 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. MedicineNet does not provide medical advice, diagnosis or treatment. 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 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. The typical recommendations for pre-operative testing include: In addition, patients may require additional tests in certain situations to help plan the operation.

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