Last, the strap muscles were dissected laterally, the omohyoid muscle and internal jugular vein (IJV) were also exposed. 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). To date, conventional open thyroidectomy through a collar incision is the standard approach to thyroidectomy (4). Call (212) 305-0444 for appointments. Only two patients developed temporary vocal cord paralysis and no patient developed permanent vocal cord paralysis. B In this case, the hemorrhage of IJV has been controlled by using Harmlock. The sternal head of the SCM was subsequently retracted to expose the strap muscles. In this operation, an incision is made in the axilla (armpit) and dissection is carried superiorly across the collar bone into the neck. This nonobese gentleman who has a 26-inch neck circumference and a large goiter would not be a candidate for any minimally invasive approach. This technique can be performed on incisions as small as 2.0 cm (0.8 inches), and generally has excellent healing and cosmetic result. If the patient was taking thyroid hormone before the operation, they should continue taking the same dose unless it was changed by the surgeon. Provided by the Springer Nature SharedIt content-sharing initiative. Surgery of the Thyroid Gland | UC Irvine Medical Center In the UK, thyroidectomy is not routinely performed under regional anaesthesia. Incision: A transverse collar incision is usually made 1-2 fingerbreaths above the sternum along the skin crease. Anaesthesia for thyroid and parathyroid surgery | BJA Education By using this website, you agree to our Surg Endosc. XYL, HOY, WBX, and ZYZ performed the study, collected the data, and contributed to the design of the study. XYL and HOY analyzed the data. MIVAT combines the small incision with use of endoscopes to help provide illumination and visualization of the tumor. 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. 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. If you experience itching once the collodion is off, you may apply lotion to the scar. 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. Mechanical retractors and incision selection. 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. 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. Is Substernal Goiter Surgery Safe? - MedicineNet The patient may be positioned with special pillows under the neck to tilt the head back. Despite the additional trauma resulting from the flap formation, the application of the trans-axillary approach is of some value in suitable circumstances. If all 4 glands are injured or removed during the operation, the blood calcium levels can become lower than normal called hypocalcemia. The MacFee incision (B) respects the relaxed skin tension lines in the neck and is therefore cosmetically superior, but it can be awkward to work through. A tube may be left in place to drain fluid and blood. The collodion will turn white and start curling up at the edges in about 5 to 7 days. In general, patients may resume taking their normal medications the day after the 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. Perhaps the most important element in optimizing access while maintaining good cosmesis is choosing the proper location for an incision. This approach accesses the thyroid through an incision inside the mouth. The natural neck crease as an anatomic landmark for thyroid surgery Most people take at least 15-30 days to recover. Trans-axillary robotically assisted approaches were first reported by Lobe et al. It provides satisfactory cosmetic outcomes compared with conventional transcervical incision. The supraclavicular lateral collar incision is a feasible and safe approach for thyroidectomy. A P value < 0.05 was considered as statistically significant. The safety of gasless endoscopic trans-axillary thyroid surgery is still undetermined. 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. Fifty-one patients (42 PTC patients and 9 thyroid adenoma patients) were included in this study. Chen GZ, Zhang X, Shi WL, Zhuang ZR, Chen X, Han H. Systematic comparison of cervical and extra-cervical surgical approaches for endoscopic thyroidectomy. wnya@Q7-$Omag[>JI[Kf;-TpOZ0v{ }b/n:WwWi4(^{=]~(O l4!|lgp$uWx)>lvK@#\K!i' y~F-yv~`=0%->s:K,z3/=K[po>@nrLo j, Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. further described gasless endoscopic thyroidectomy through the axillary region, which can effectively avoid the influences of carbon dioxide [8]. Although conventional thyroidectomy has successful surgical outcomes, robotic minimally invasive procedures, known for their scar free (regarding the neck, no collar incision) surgical outcomes gained popularity through the years. Figure 42-5 Delivery of a thyroid lobe through a minimal access incision (A), which is just big enough to admit the gland. 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.
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