collar incision for thyroidectomy

2.5cm . This hardening will peak at about 3 weeks and may result in some tightness especially when swallowing or extending your neck. Excellent long-term cosmetic outcomes can be expected with minimally invasive endoscopic thyroid surgery (B). also reported a study concerning the gasless trans-axillary thyroidectomy with the assistance of robots. Specific procedural considerations are described, and then a concise enumeration of proposed best practices is offered. After the seventh day, reduce the calcium to one Tums Ultra 1000 tablet three times a day until your follow-up appointment. Most of the time, the surgery can be done this way. Thyroid cancer is an increasingly prevalent malignancy worldwide [].Surgery is the most commonly used technique in treating thyroid diseases. The surgeon makes a cut (incision) in the lower part of the neck just above the collar bone to determine if the mass can be removed without opening the chest. Symptoms of hypocalcemia include numbness and tingling in your hands, soles of your feet and around your lips. The sternal head of the SCM was subsequently retracted to expose the strap muscles. 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. WBX and ZYZ drafted the Result, Discussion, and Conclusion sections. In this study, 51 patients accepted gasless, endoscopic trans-axillary thyroid surgery with only one patient whose operation was converted to open surgery. Lee et al. 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. 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. 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. Medical records were reviewed retrospectively. 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. 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. COVID-19 News: Vaccine Info | In Person Visits | Virtual Visits. This percent decreases in older women, patients with a personal or family history of Hashimoto's thyroiditis or hypothyroidism, and patients with a family history of autoimmune disease. A This case has been converted to open surgery. The size of the incision is dictated by surgeon preference and need for adequate exposure to remove the tumor. The follow-up times were 3 to 10 months. revealed that trans-axillary thyroidectomy was associated with a better cosmetic index, however, it was also associated with a longer operation time, aggravated voice changes, paresthesia, and changes in swallowing function [18]. No internal jugular vein injury was reported [19]. . 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)). A number of surgical procedures and surgical approaches have been developed and the terminology can be confusing. XYL and HOY analyzed the data. Indications: Proven neoplasm (FNAC) Suspected neoplasm Age: Extreme Sex: Male How is substernal goiter surgery performed? This procedure ensures patients cosmetic needs by making incisions under the axilla, which allows for the removal of nodules, even large nodules [7]. 2016;23:694700. They are typically not dangerous unless cancer cells develop in the goitrous thyroid enlargement. 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. Your incision will be located on the front of your neck. 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. Preoperative fine-needle aspiration cytology (FNAC) suggested malignancy in 42 patients, where lobectomy and prophylactic unilateral central neck dissection were performed. Temporary numbness of the anterior chest is very common after this operation, and can last for several months. 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. PubMedGoogle Scholar. These nerve control the vocal cords. The mean age was 34 years old, ranging from 19 to 45 years. Ann Surg Oncol. Indications for removal of the gland include most types of thyroid cancer, large goiters causing compression of the airway, and Graves disease. 0 Article Endocr J. Goiters may be a result of the over or underproduction of the thyroid hormone or the presence of nodules in the thyroid gland. Patients who spend the night in the hospital are typically discharged by 10AM the next morning. This test is used in patients with large goiters, substernal goiters, and cases of advanced cancer. This surgical procedure is known as athyroidectomy. 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. Because the thyroid gland is situated directly in front of the trachea, or windpipe, airway obstruction may occur if blood collects in the area after surgery. In the hands of an experienced thyroid surgeon, thyroid surgery is a safe procedure with few complications. The primary surgeon performs surgery by manipulating the instruments in the robotic arms from a console adjacent to the patient, and a bedside surgical assistant can change instruments on the robotic arms, and perform additional tasks to support the primary surgeon. Retractor was placed beneath the strap muscles to finish creating the working space (Fig. However, thyroidectomy is still difficult because the thyroid gland is rich in blood supply and is adjacent to parathyroid glands and important nerves. Prophylactic unilateral lymphadenectomy was also routinely performed among patients with thyroid cancer including the prelaryngeal, pretracheal, and ipsilateral paratracheal areas (Fig. In about 5% of patients who have thyroid surgery, the parathyroid glands do not function properly immediately after thyroid surgery. 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. The Procedure of Traditional Low Collar Incision Thyroidectomy The patient was placed in the supine position neck hyperextension. %PDF-1.6 % 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. Have certain genes or a family member with goiters. Both lobes of the thyroid were noted to be enlarged. 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. The collodion will turn white and start curling up at the edges in about 5 to 7 days. 79 0 obj <>stream The mean number of lymph nodes removed by unilateral CND was 3.15 3.2 (range 212) in PTC patients. J Laparoendosc Adv Surg Tech A. Substernal goiter can be removed through a relatively straightforward collar incision in the lower neck. Some people experience a dull ache, while others feel a sharp pain. Patients now expect a more measured approach to their care, which sometimes includes quite small incisions (Figure 42-5). If any of these symptoms happen, the patient should call 911 first and then their surgeon. Google Scholar. Endoscopic versus conventional thyroid surgery: a comparison of quality of life, cosmetic outcomes and overall patient satisfaction with treatment. 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. The dose of thyroid hormone is usually based on the person's weight. 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. Piccoli et al. Incisions as small as 1 inch (2.5 cm) can be performed for patients with favorable neck anatomy and small tumors. During the limited follow-up periods, no recurrence has been found. A number of technological advances such as advanced energy devices for hemostasis. 32 0 obj <> endobj World J Surg. 2). hXms8+/3@6]H1|p@/IBd`zc[Vx}iJL8t3\bDgX&#&'8N,0f2Pq6PbYD\f(6uiMlJt]#aZal14t FlJNlCO} Terms of Use. 2017;27:115864. 2021; https://doi.org/10.1007/s00464-021-08424-y. World J Surg Oncol. Gasless single incision trans-axillary thyroidectomy: the feasibility and safety of a hypo-morbid endoscopic thyroidectomy technique. Thyroid Nodules Diagnosis and Treatment , Follicular Thyroid Cancer/ Hurthle Cell Carcinoma. 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. further described gasless endoscopic thyroidectomy through the axillary region, which can effectively avoid the influences of carbon dioxide [8]. Although the risk of these complications cannot be eliminated entirely, they can be minimized in the hands of an experienced thyroid surgeon. 2020;44:411826. 4). In each patient, the indication for surgery was a small nodule of unclear malignant potential. Poor cosmetic result from scarring of the neck or axillary incision may occur and require secondary scar management. 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. Chen GZ, Zhang X, Shi WL, Zhuang ZR, Chen X, Han H. Systematic comparison of cervical and extra-cervical surgical approaches for endoscopic thyroidectomy. In the hands of our Columbia Thyroid Center surgeons, the chance of having a temporary hoarseness is 3% and the chance of having a permanent hoarseness is less than 1%. Figure 42-4 Examples of the so-called necklace neck incision associated with a classical thyroidectomy through an open approach (A and B). 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. When the goiter is caused by a noncancerous. This test is used in patients with hoarseness, a previous neck operation, or cases of advanced cancer. Kang JB, Kim EY, Park YL, Park CH, Yun JS. Novel uses of surgical robotics in head and neck surgery. The exceptions are blood thinners, aspirin, Plavix, and anti-thyroid medications like PTU and Methimazole. Temporarily lowered calcium levels occur in approximately 15-40% of patients, and is treatable with calcium and vitamin D supplementation post-operatively. Surgery is typically recommended for goiters that are causing symptoms. These symptoms appear between 24 and 48 hours after surgery. Trans-axillary robotically assisted approaches were first reported by Lobe et al. 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. 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. The time of LT with or without CND was 40.9 15.1 min (range 3090 min). 1). Huang Z, Qin H, Liao J, Meng L, Qin Y, Li B, et al. Surg Today. 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. In any case, the surgical team must be ready for complications from massive goiter surgery, such as: Substernal goiter can be removed through a relatively straight forward collar incision in the lower neck. MedicineNet does not provide medical advice, diagnosis or treatment. Lee DY, Oh DJ, Kang KR, Kim MS, Oh KH, Baek SK, et al. 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. 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. You can shower and wash your hair as usual, but do not soak or scrub the incision. B In this case, the hemorrhage of IJV has been controlled by using Harmlock. Cir Esp (Engl Ed). 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. It is no longer sufficient to remove a thyroid, preserve the laryngeal nerves, and preserve the parathyroid glands (Figure 42-4). TR}Iu9!'\2q/ HOW BIG WILL THE INCISION BE? Rarely, nerve injury to the arm can occur, resulting in impaired arm and/or hand function. 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. Several reports with large case cohorts were regarding robotically assisted thyroidectomy [8,9,10]. WHERE WILL THE INCISION BE? The skin and subcutaneous tissues were separated, and subplatysmal . This suggests that discomfort in the anterior neck area and SCM is obvious shortly after surgery and is relieved over time in most cases. Most patients will feel like they have a sore throat for the first few days after the operation, especially when swallowing. In addition to the complications of standard thyroid surgeries listed below, there are several complications specific to this operation. Only two patients developed temporary vocal cord paralysis and no patients developed other severe complications. It is not common to need these additional tests, but they may include: Fiberoptic laryngoscopy: This test allows the surgeon to look at how well the vocal cords are moving by passing a thin flexible camera through the nose into the airway. 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. J Minim Access Surg. It is critical to work with a team of thyroid specialists to choose the right operation for each individual patient. If all 4 glands are injured or removed during the operation, the blood calcium levels can become lower than normal called hypocalcemia. 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. Perhaps the most important element in optimizing access while maintaining good cosmesis is choosing the proper location for an incision. Some patients experience a "crawling" sensation in the skin, muscle cramps or headaches. After the seventh day, reduce the calcium to one Tums Ultra 1000 tablet three times a day until your follow-up appointment. Patients in two groups underwent thyroidectomy through a supraclavicular lateral collar incision (approximately 5 cm). This helps to ensure proper wound healing in the postoperative period. 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. It seems no consensus has been reached on the clinical application of this technique considering the discrepant complications rate. Berber E, Bernet V, Fahey TJ 3rd, Kebebew E, Shaha A, Stack BC Jr, et al. Thyroid cancer can also spread to the lateral neck. + )&`30^2{[b#nuwUhSr e4vMHCH qOmo.S2:uZN|/L.J. Kang SW, Jeong JJ, Yun JS, Sung TY, Lee SC, Lee YS, et al. 2 ). B, With wide elevation of subplatysmal flaps, all levels of the neck are accessible. 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. %%EOF The complications, including hypoparathyroidism, tracheal injury, esophageal injury, or surgical site infection did not occur. Acceptable wound cosmetology has . 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. Most people will not be able to notice the incision once the redness fades away. This approach involves making an incision in the center of your neck to directly access your thyroid gland. Thyroid nodules and cancer management guidelines: comparisons and controversies. However, it also leads to greater trauma [22]. Kendall Jenner and her new love Bad Bunny were both seen arriving at the Mark Hotel in New York City on Monday ahead of their anticipated arrival at the Met Gala later in the evening. 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 After a completion thyroidectomy, patients will need to take thyroid hormone replacement pills (one pill a day for the rest of their lives). 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. This work was supported by the National Natural Science Foundation of China (grant No. It provides a good alternative beyond 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.9 Historically, surgeons proposing to accomplish a thyroidectomy would make a standard length incision in a routine location and accomplish an identical operation for each patient. With this type of anesthesia, you are completely asleep during the operation, and you will have a breathing tube placed temporarily to protect your airway and lungs. Endoscopic thyroidectomy. To date, conventional open thyroidectomy through a collar incision is the standard approach to thyroidectomy (4). The recurrent laryngeal nerves were clearly identified and preserved in all cases. However, the rate of complications is higher in individuals older than 60 years of age. This procedure may also be appropriate for small, non-aggressive thyroid carcinomas less than 1cm. The location of the tumor was right, n= 30; left, n= 21. This nonobese gentleman who has a 26-inch neck circumference and a large goiter would not be a candidate for any minimally invasive approach. 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. This chapter contains additional online-only content, available on expertconsult.com. When present, surgical removal is generally indicated. 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. Many companies make these suits, and they're washable and reusable. Koh YW, Park JH, Kim JW, Lee SW, Choi EC. Written informed consent for publication of their clinical details and clinical images was obtained from all patients. 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. Kim EY, Lee KH, Park YL, Park CH, Lee CR, Jeong JJ, et al. A 5- to 7-cm arc incision was made along the dermatoglyphic direction, 1-2 cm above the sternal notch. Fifty-one patients (49 females and 2 males) received operations by gasless, endoscopic trans-axillary approaches with one patient whose operation was converted to open surgery because of internal jugular vein injury. As the working space is crucial to the surgery and time-consuming, the time of working space makes and thyroidectomy were calculated separately. Rarely, a surgeon may open the sternum (chest) to remove the goiter. Surg Endosc. Only gold members can continue reading. All data generated or analyzed during this study are included in this published article. 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.

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