collar incision for thyroidectomy

Endocr J. The size of the incision is dictated by surgeon preference and need for adequate exposure to remove the tumor. 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. Surg Endosc. have been classified as minimally invasive. 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. 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. 2016;26:3317. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. Surg Endosc. endstream endobj startxref Transoral thyroidectomy. Most patients will feel like they have a sore throat for the first few days after the operation, especially when swallowing. 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. Some people experience a dull ache, while others feel a sharp pain. 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 Advantages of Robotic Over Open Thyroidectomy in Thyroid - PubMed However, the rate of complications is higher in individuals older than 60 years of age. 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. 0 The safety of gasless endoscopic trans-axillary thyroid surgery is still undetermined. After the seventh day, reduce the calcium to one Tums Ultra 1000 tablet three times a day until your follow-up appointment. However, the da Vinci system is blamed for a prolonged surgery duration and a significantly higher economic cost. A seroma is a collection of fluid under the incision. Privacy World J Surg. Endoscopic versus conventional thyroid surgery: a comparison of quality of life, cosmetic outcomes and overall patient satisfaction with treatment. The addition of robotics can improve surgical dexterity in a difficult-to-reach anatomic region [6]. The average drainage volume was 48.0 24.4 ml (20100 ml) on day one and 13.7 5.6 ml (1030 ml) on day two. The recurrent laryngeal nerve provides nerve input to the vocal cords, and is also intimately involved with the thyroid gland. In the hands of an experienced thyroid surgeon, thyroid surgery is a safe procedure with few complications. Chapter 42 Incisions in Thyroid and Parathyroid Surgery. In any case, the incision should be parallel to relaxed skin tension lines, following classic cosmetic principles. A 5-6 cm transverse collar skin incision was made into the midline of the anterior neck 2 cm above the sternal notch. B A 4-cm length incision was made in the natural wrinkle of axilla and an accessory 5-mm incision was made for another operative instrument, Three standard steps method for working space make. All existing creases can be mapped out in order to configure an incisional line that is parallel to a regional crease. A number of important principles are worth considering when planning a thyroidectomy or parathyroidectomy, and these transcend the specific procedure that is anticipated. Acceptable wound cosmetology has . statement and 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. All authors made substantive intellectual contributions to this study to qualify as authors. AN INCISION (CUT) THAT WILL REQUIRE SPECIAL CARE. The most recent trend has been to perform thyroid surgery while avoiding any neck incision at all. 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]. Classically 8-12 cm (3-5 inch) incisions were performed. hb`````Jg`a`6Tcg@ ~+s\``fy$ S@5@YN@ZA:V^`` HWy6rC+1oxD7`v`Xvz&fq=@&2` &{^j@ 8S 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. In any case, the incision should be parallel to relaxed skin tension lines, following classic cosmetic principles.10. While the conventional collar incision is widely used, endoscopic thyroidectomy is gradually becoming accepted for thyroid nodule patients with cosmetic needs [2,3,4]. We also recommend a multivitamin for most patients. Thyroidectomy without Ligatures in Differentiated Thyroid Cancer The typical recommendations for pre-operative testing include: In addition, patients may require additional tests in certain situations to help plan the operation. There are a number of factors that affect suitability for this procedure. Endoscopic Lateral Neck Dissection: A New Frontier in Endoscopic Many companies make these suits, and they're washable and reusable. This procedure may also be appropriate for small, non-aggressive thyroid carcinomas less than 1cm. Frontiers | Comparison of Supraclavicular Oblique Incision With Kocher himself, however, recognized the logic behind utilizing as small an incision as possible and is quoted as saying thyroidectomy incisions should be as small as possible, as big as necessary, therefore perhaps qualifying him as the first minimally invasive surgeon. Acceptable wound cosmetology has become a focus for thyroid surgeons. Chen GZ, Zhang X, Shi WL, Zhuang ZR, Chen X, Han H. Systematic comparison of cervical and extra-cervical surgical approaches for endoscopic thyroidectomy. Endoscopic and robotic thyroidectomy for cancer. Last, the strap muscles were dissected laterally, the omohyoid muscle and internal jugular vein (IJV) were also exposed. . Collar incision was made about 2 1/2cm above the inner ends of the clavicle, through the platysmal muscle.. 2.5cm . 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. Figure 42-5 Delivery of a thyroid lobe through a minimal access incision (A), which is just big enough to admit the gland. In the past decade, advancements in A c c e p t e d . After a completion thyroidectomy, patients will need to take thyroid hormone replacement pills (one pill a day for the rest of their lives). Manage cookies/Do not sell my data we use in the preference centre. 2020;34:1891903. Rarely, a patient may have temporary changes in the voice such as fluctuations in volume and clarity (hoarseness). The patients were either satisfied or very satisfied with the cosmetic effects. 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 risk of having any of these complications depends on the experience of the surgeon. As the scar heals, it will appear to be part of the crease and thus camouflage it. 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. Lee DY, Oh DJ, Kang KR, Kim MS, Oh KH, Baek SK, et al. In addition to using very small incisions, our surgeons "hide" the incision in a natural skin crease which acts like camouflage. Substernal goiter can be removed through a relatively straightforward collar incision in the lower neck. Closure of skin incision after thyroidectomy through a supraclavicular All data generated or analyzed during this study are included in this published article. Thyroid cancer is an increasingly prevalent malignancy worldwide [1]. Analysis of preoperative influential factors and construction of a Comparison of learning curves for retroauricular and transaxillary endoscopic hemithyroidectomy. Endoscopic thyroidectomy. This approach uses smaller incisions in the neck. A The superior thyroid vessels were individually ligated. The hockey-stick incision (C) avoids trifurcations and provides plentiful exposure for a comprehensive neck dissection. Specific procedural considerations are described, and then a concise enumeration of proposed best practices is offered. They will be monitored closely as they need to recover from the anesthesia. Thus, gasless endoscopic thyroidectomy without the assistance of robots might be more suitable. Temporary numbness of the anterior chest is very common after this operation, and can last for several months. This chapter contains additional online-only content, available on expertconsult.com. Feeling that something is stuck in the throat. https://doi.org/10.1186/s12957-021-02484-z, DOI: https://doi.org/10.1186/s12957-021-02484-z. The final pathology is ready approximately1 week after the operation. Thyroid. If you are dealing with a thyroid issue, our team at the Columbia Thyroid Center is here to help. 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. This suggests that discomfort in the anterior neck area and SCM is obvious shortly after surgery and is relieved over time in most cases. 2009;146:104855. The parathyroid glands control calcium homeostasis within the body. Thyroidectomy - Mayo Clinic Thyroid storm, also called thyrotoxic crisis, is a life-threatening medical emergency caused by very high levels of circulating thyroid hormone. 2012;42:83541. Medscape. Classically 8-12 cm (3-5 inch) incisions were performed. This technique can be performed on incisions as small as 2.0 cm (0.8 inches), and generally has excellent healing and cosmetic result. For images of a functional neck dissection, see following images. Surg Today. In addition to classifying the extent of surgical resection, a number of surgical approaches have been described. Thyroidectomy: What It Is, Complications & Recovery - Cleveland Clinic J Laparoendosc Adv Surg Tech A. Gasless, endoscopic trans-axillary thyroid surgery: our series of the first 51 human cases, https://doi.org/10.1186/s12957-021-02484-z, https://doi.org/10.1007/s00464-021-08424-y, https://doi.org/10.1007/s00464-020-07814-y, http://creativecommons.org/licenses/by/4.0/, http://creativecommons.org/publicdomain/zero/1.0/. Fortunately, in the hands of Columbia Thyroid Center surgeons, the risk of bleeding is less than 1%. A P value < 0.05 was considered as statistically significant. Short and long-term cosmesis of cervical thyroidectomy scars To date, conventional open thyroidectomy through a collar incision is the standard approach to thyroidectomy (4). We have been using this approach since 1999. low collar incision The trans-axillary approach (TA) can hardly locate the contralateral thyroid lobe, causing the limitation of TA in bilateral thyroidectomy. Only gold members can continue reading. Robotic thyroid surgery using a gasless, transaxillary approach and the da Vinci S system: the operative outcomes of 338 consecutive patients. Nabhan F, Ringel MD. XYL and HOY analyzed the data. Comparison between 3-dimensional and 2-dimensional endoscopic thyroidectomy for benign and malignant lesions: a meta-analysis. Call (212) 305-0444 for appointments. Springer Nature. Consideration should be given to breast size, especially in younger women, as over time the incision will be pulled downward if the breasts are large and pendulous. The standard incision is best placed above this suprasternal notch. 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. Part of Berber E, Bernet V, Fahey TJ 3rd, Kebebew E, Shaha A, Stack BC Jr, et al. The sternal head of the SCM was subsequently retracted to expose the strap muscles. 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. Poor cosmetic result from scarring of the neck or axillary incision may occur and require secondary scar management. Incisions as small as 1 inch (2.5 cm) can be performed for patients with favorable neck anatomy and small tumors. 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. Thyroidectomy Basics | Epomedicine Surg Endosc. The rate of permanently low calcium levels after a total thyroidectomy is anywhere from 1-5%. Correspondence to Excellent long-term cosmetic outcomes can be expected with minimally invasive endoscopic thyroid surgery (B). Koh YW, Park JH, Kim JW, Lee SW, Choi EC. . Thyroid cancer can also spread to the lateral neck. The primary advantage of this surgical procedure is avoidance of an incision on the neck. Terms of Use. By using this website, you agree to our Parathyroidectomy 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 alleviation of the discomfort in the anterior neck area and sternocleidomastoid, and the cosmetic effect of gasless endoscopic trans-axillary thyroid surgery were acceptable. (PDF) Incision Length for Standard Thyroidectomy and - ResearchGate The time of LT with or without CND was 40.9 15.1 min (range 3090 min). It is noteworthy that there is another obvious disadvantage of this technique. Fada Xia. 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. Continuous variables are presented as the mean SD and the mean (range). Although the numbers of identified parathyroid glands have not been calculated, we considered that the recognition and protection of the parathyroid gland would get improvement with the growing experience. After surgery, the patient will stay in the recovery room for several hours. 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. Compared to two-dimensional endoscopic thyroidectomy, three-dimensional endoscopic thyroidectomy is an efficient, safe, and reliable method with better depth perception and stereoscopic vision, and an equally satisfactory outcome [23]. The first lymph nodes to be involved are generally the paratracheal lymph nodes. B, C The recurrent laryngeal nerve (RLN) was identified and then traced. Google Scholar. 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. 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, the risk of damage to this nerve must be understood prior to surgery. This study was approved by the Institutional Ethics Committee of Xiangya Hospital, Central South University (No.202011960). The middle thyroid vein was then ligated. 2016;23:40238. This approach accesses the thyroid through an incision inside the mouth. Surgery of the Thyroid Gland | UC Irvine Medical Center COT allows good direct exposure for both thyroid lobes and central neck compartment. Modern thyroid surgery found its origins in the late 19th century in the work of Billroth and Kocher.7 Although Billroth is credited with first systematically pursuing thyroidectomy in a deliberate fashion, it was Kocher who developed a safe and reproducible technique for accomplishing a therapeutic thyroidectomy. Gasless, endoscopic trans-axillary thyroid surgery: our series of the It is uncommon, but when it occurs after thyroidectomy, it is usually associated with Grave's disease. The size of the incision is dictated by surgeon preference and need for adequate exposure to remove the tumor. It provides satisfactory cosmetic outcomes compared with conventional transcervical incision. For standard-length incisions, a good alternate choice, if a normal symmetrical crease is not available, is a line parallel to a normal skin crease. Thus, the outcome of substernal goiter surgery is usually good. Indications for this procedure include unilateral goiter and unilateral benign thyroid nodules. Jiang WJ, Yan PJ, Zhao CL, Si MB, Tian W, Zhang YJ, et al. 4 Technologic Minimally invasive thyroid surgery refers to certain types of surgery in which the thyroid is removed through very small incisions using special techniques. In general, patient should be able to eat their normal diet, but most patients prefer softer foods for the first few days. Some patients experience a "crawling" sensation in the skin, muscle cramps or headaches. 82073262) and the Hunan Province Natural Science Foundation (grant number 2021JJ41033 and 2019JJ40475). 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. The dissected area is marked in blue, The procedure of thyroidectomy and central neck dissection (CND). E, F Step three, the strap muscles were dissected laterally and the retractor was placed beneath the straps muscle to expose the thyroid lobe. If all 4 glands are injured or removed during the operation, the blood calcium levels can become lower than normal called hypocalcemia. The opposite lobe is not removed, and in general the remaining thyroid gland will produce enough thyroid hormone for the body. The paratracheal lymph nodes are divided into pretracheal, prelaryngeal, and right and left lateral paratracheal lymph nodes. Application of lateral supraclavicular incision in unilateral thyroid Acceptable wound cosmetology has . At the Columbia Thyroid Center, 95% of our patients are able to go home after a 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). 1996-2023 MedicineNet, Inc. An Internet Brands company. The optimal position in which to mark the anticipated thyroid incision is with the patient seated upright in the holding area. It provides a good alternative beyond Please see the Expert Consult website for more discussion of this topic, including Figure 42-1. If the patient was not taking thyroid hormone prior to the operation, the surgeon may prescribe these tablets following surgery. https://emedicine.medscape.com/article/2051665-overview. While the majority of patients accept a thyroidectomy scar, a certain percentage of patients are not satisfied with a visible scar on the neck. It is nearly always preferable to identify and utilize a preexisting skin crease (if present), as this will result in the most optimally camouflaged scar. Compared with conventional approach, it holds the advantages of comparative extensive indications and similar complication rate but achieving a better cosmetic result. When the goiter is caused by a noncancerous.

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