collar incision for thyroidectomy

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 . Popular incisions included the Lahey incision (Figure 42-1. By using this website, you agree to our The risk of having any of these complications depends on the experience of the surgeon. 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. 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. Even in the rare chance of having a permanently hoarse voice, there are things that can be done to improve or fix the voice. further described gasless endoscopic thyroidectomy through the axillary region, which can effectively avoid the influences of carbon dioxide [8]. 0 Mechanical retractors and incision selection. 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. The neck was entered through a collar incision, and bleeding was controlled with electrocautery. 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. 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. The traditional "Kocher incision", an 8-10 cm collar incision, is regarded as the conventional appropriate incision for thyroidectomy.2 However, many new approaches for thyroid surgery were developed in order to further minimize the size of the surgical incision.3 Post-thyroidectomy scars have a negative effect on quality of life. The nodes may be referred to as level 6 lymph nodes based on the AJCC staging criteria. Indications for removal of the gland include most types of thyroid cancer, large goiters causing compression of the airway, and Graves disease. 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. All rights reserved. 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 . After a completion thyroidectomy, patients will need to take thyroid hormone replacement pills (one pill a day for the rest of their lives). 2 ). The average blood loss for this operation is less than a tablespoon and the chance of needing a blood transfusion is extremely rare. Incisions in Thyroid and Parathyroid Surgery | Ento Key + )&`30^2{[b#nuwUhSr e4vMHCH qOmo.S2:uZN|/L.J. In addition to the complications of standard thyroid surgeries listed below, there are several complications specific to this operation. PDF Creative Commons License [CC BY-NC-ND 4.0] 2022 The Author(s Thyroid nodules and cancer management guidelines: comparisons and controversies. A This case has been converted to open surgery. 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 4-cm length incision was made just behind the anterior axillary fold for the laparoscope (a rigid 30-degree videoscope) and one operating instrument. In this operation, an incision is made in the axilla (armpit) and dissection is carried superiorly across the collar bone into the neck. 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. Due to this rare risk of bleeding, patients are observed for 4 hours by our highly trained recovery room staff. https://emedicine.medscape.com/article/2051665-overview. 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 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. 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. Kim EY, Lee KH, Park YL, Park CH, Lee CR, Jeong JJ, et al. Comparison of total endoscopic thyroidectomy with conventional open thyroidectomy for treatment of papillary thyroid cancer: a systematic review and meta-analysis. This helps to ensure proper wound healing in the postoperative period. The trans-axillary approach (TA) can hardly locate the contralateral thyroid lobe, causing the limitation of TA in bilateral thyroidectomy. Sensory changes around the anterior chest and paralysis of the sternocleidomastoid muscle were evaluated by VRSs. Minimally invasive thyroid surgery refers to certain types of surgery in which the thyroid is removed through very small incisions using special techniques. Moreno Llorente P, E AGL, Alberich Prats M, Francos Martnez JM, Garca Barrasa A. Surgical approaches to thyroid. Endoscopic thyroidectomy. Google Scholar. It is important to note that numbness and tingling may be caused by something other than a parathyroid problem. 2013;22:113. The recurrent laryngeal nerve provides nerve input to the vocal cords, and is also intimately involved with the thyroid gland. Surg Endosc. OMIT is an open thyroidectomy performed through a short 'collar' incision and does not necessitate special equipment although two assistants are desirable. Department of General Surgery, Xiangya Hospital, Central South University, No. B, C The recurrent laryngeal nerve (RLN) was identified and then traced. With the transformation of thyroid and parathyroid surgery since the late 1990s, there are now a variety of methods for accessing the thyroid and central neck. Bleeding is a rare complication and those few patients who do have a bleeding problem almost always have it during the 4 hour observation period in the recovery room. Because of the risk of hypertrophic scarring, we recommend resecting a sliver of skin edge whenever and wherever this is recognized (Figure 42-7). Only gold members can continue reading. COT allows good direct exposure for both thyroid lobes and central neck compartment. It is uncommon, but when it occurs after thyroidectomy, it is usually associated with Grave's disease. 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. While the majority of patients accept a thyroidectomy scar, a certain percentage of patients are not satisfied with a visible scar on the neck. This approach involves making an incision in the center of your neck to directly access your thyroid gland. Kang SW, Lee SC, Lee SH, Lee KY, Jeong JJ, Lee YS, et al. A, An extended low cervical collar incision is used when a lateral neck dissection is indicated. Kendall Jenner and Bad Bunny arrive at the Mark Hotel before Met Gala Please see the Expert Consult website for more discussion of this topic. Most patients (97%) will not notice any change in their voice after the operation. Under the premise of oncological effectiveness, endoscopic thyroidectomy can provide a safe option for these patients [5]. With the transformation of thyroid and parathyroid surgery since the late 1990s, there are now a variety of methods for accessing the thyroid and central neck. Several reports with large case cohorts were regarding robotically assisted thyroidectomy [8,9,10]. However, the rate of complications is higher in individuals older than 60 years of age. A The superior thyroid vessels were individually ligated. The skin and subcutaneous tissues were separated, and subplatysmal . You might notice bruising around your incision or upper chest and slight swelling above the scar when you are upright. Patients with other significant medical issues may be asked to visit with their medical team to obtain a letter of medical clearance. How is substernal goiter surgery performed? 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. Most patients may need to take thyroid hormone pills (thyroid hormone replacement) for the rest of their lives when the whole thyroid gland is removed. In about 5% of patients who have thyroid surgery, the parathyroid glands do not function properly immediately after thyroid surgery. The stiffness and paraesthesia of the SCM resulting from the division of the SCM are also relieved over time. Symptoms of hypocalcemia include numbness and tingling in your hands, soles of your feet and around your lips. 2010;24:18897. [] Thyroidectomy : The first lymph nodes to be involved are generally the paratracheal lymph nodes. Lee DY, Oh DJ, Kang KR, Kim MS, Oh KH, Baek SK, 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. The safety of gasless endoscopic trans-axillary thyroid surgery is still undetermined. Minimally invasive thyroidectomy is a surgical approach to remove the thyroid gland through smaller incisions. We also recommend a multivitamin for most patients. Ryan WR. 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. Permanent nerve damage occurs in approximately 1% of cases performed by a skilled surgeon. Anaesthesia for thyroid and parathyroid surgery | BJA Education MedicineNet does not provide medical advice, diagnosis or treatment. Substernal Goiter Surgery. Surgery. 2011;25:161723. Figure 42-4 Examples of the so-called necklace neck incision associated with a classical thyroidectomy through an open approach (A and B). Figure 42-7 When a large thyroid lobe is delivered through small incisions, it is not uncommon to observe evidence of an ischemic or traumatized skin edge (A). Thyroid Nodules Diagnosis and Treatment , Follicular Thyroid Cancer/ Hurthle Cell Carcinoma. a skin incision was made using scalpel, Thyroid storm, also called thyrotoxic crisis, is a life-threatening medical emergency caused by very high levels of circulating thyroid hormone. Have certain genes or a family member with goiters. In the past decade, advancements in A c c e p t e d . The retractors (Kangji, Hangzhou, China) were used to maintain the working space during the operation. XYL, HOY, WBX, and ZYZ performed the study, collected the data, and contributed to the design of the study. Call (212) 305-0444 or request an appointment online. Furthermore, the sensory change and paralysis results from this technique and patients satisfaction with the cosmesis were also studied. In this study, we reported our initial experiences with 51 patients who underwent gasless endoscopic trans-axillary thyroid surgery performed by a single experienced surgeon. Indications: Proven neoplasm (FNAC) Suspected neoplasm Age: Extreme Sex: Male 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. Closure of skin incision after thyroidectomy through a supraclavicular Article The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. 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. Conventional thyroidectomy In a conventional thyroidectomy, a 3- to 4-inch incision will be made through the skin in the low collar area of your neck (the lower front portion of your neck, above the collarbones and breast bone). Please see the Expert Consult website for more discussion of this topic, including Figure 42-1. As the sternal head of the SCM was elevated by the retractor during the procedure, the decreased VRSs may be partly due to the shorter surgical time and improved surgical techniques. Expert thyroid care for adults and children. The dose of thyroid hormone is usually based on the person's weight. After a total thyroidectomy, patients will need to take thyroid hormone replacement pills (one pill a day for the rest of their lives). 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. Most patients will feel like they have a sore throat for the first few days after the operation, especially when swallowing. Routine level 2b dissection may be recommended only in N1b papillary thyroid carcinoma with three- or four-level lateral lymph node metastasis. 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. As the scar heals, it will appear to be part of the crease and thus camouflage it. . 2017;92:914. 2012;42:83541. It has been pointed out by Kang et al. A number of technological advances such as advanced energy devices for hemostasis,1 high-resolution endoscopes for improved visualization,2 and laryngeal nerve monitoring3 have increased the focus on cosmetic outcomes and the pursuit of smaller, well-camouflaged incisions.4 Also emerging are techniques for remote access thyroid and parathyroid surgery.5,6 Conventional surgery remains necessary in many circumstances, such as for large substernal goiters or advanced malignancy, and will remain in the endocrine surgeons armamentarium. Rong Cong and Xinying Li contributed equally to this work. With careful preoperative testing and thoughtful consideration of the type of anesthesia, including the type of intubation, preparation for surgery can be optimized. 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. Second, we divided the area between the sternal and clavicular head of the SCM, up to the annular cartilage and down to the clavicle. A seroma is a collection of fluid under the incision. 2021;19:23. The rate of permanently low calcium levels after a total thyroidectomy is anywhere from 1-5%. Patients should call their surgeon's office to make a follow up appointment 3 weeks after surgery. 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. Fada Xia. 2006;10:20611. Gasless, endoscopic trans-axillary thyroid surgery: our series of the Berber E, Bernet V, Fahey TJ 3rd, Kebebew E, Shaha A, Stack BC Jr, et al. The contribution of the incision to the cosmetic outcome does not end with the making of the incision itself. 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. At the Columbia Thyroid Center, 95% of our patients are able to go home after a 4 hour observation period in the recovery room. Medical records were reviewed retrospectively. Gasless endoscopic thyroidectomy using trans-axillary approach; surgical outcome of 581 patients. 2017;24:R1326. 1999-2022. This work was supported by the National Natural Science Foundation of China (grant No. 2011;25:135863. Statistical analyses were conducted using the Students t test and one-way ANOVA through the SPSS 23.0 software. 2016;23:694700. This study kept the confidentiality of patient data and strictly complied with the Declaration of Helsinki and its later amendments or comparable ethical standards. 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). For persons with pre-existing shoulder abnormalities, these could be exacerbated by surgery. Only two patients developed temporary vocal cord paralysis and no patients developed other severe complications. A thyroid lobectomy may be done for a variety of diseases including indeterminate lesions on fine needle biopsy (See Thyroid Nodules Diagnosis and Treatment ), a toxic nodule (See Hyperthyroidism ), substernal goiter, and an enlarging thyroid nodule, among others. Because these structures are intimately associated with the thyroid gland, your calcium levels may be affected either temporarily or permanently after thyroid surgery. The parathyroid glands control calcium homeostasis within the body. 1996-2023 MedicineNet, Inc. An Internet Brands company. J Laparoendosc Adv Surg Tech A. As the working space is crucial to the surgery and time-consuming, the time of working space makes and thyroidectomy were calculated separately. volume20, Articlenumber:9 (2022) Thyroid Surgery Recovery, Side Effects, and Complications - Verywell Health Thyroidectomy: Overview, Preparation, Technique - Medscape Johri G, Chand G, Mishra A, Mayilvaganan S, Agarwal G, Agarwal A, et al. This procedure ensures patients cosmetic needs by making incisions under the axilla, which allows for the removal of nodules, even large nodules [7]. The patient may be positioned with special pillows under the neck to tilt the head back. Call (212) 305-0444 for appointments. However, the da Vinci system is blamed for a prolonged surgery duration and a significantly higher economic cost. All authors have no conflicts of interest or financial ties to disclose. The collodion will turn white and start curling up at the edges in about 5 to 7 days. You can shower and wash your hair as usual, but do not soak or scrub the incision. 2005;15:64752. 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. Due to the working space needed for the flap formation and division of the SCM during an axillary approach, this technique is more time-consuming.

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