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Which surgical approach is right for me?
The fact is, most surgical incisions for thyroidectomy and parathyroidectomy heal relatively well and are fairly inconspicuous. There are many surgeons in the country who can provide conventional thyroid or parathyroid surgery safely.
For some people, however, the standard three- to four-inch incision is undesirable. This is particularly true for children or young women, but depending on a person's individual point of view, anyone may prefer to have a smaller incision or to shorten their recovery period.
Not everyone is a candidate for a small incision. Previously operated patients or those with aggressive cancer or very large tumors may not be candidates. It is also possible that a small incision will have to be made larger for safety of the procedure.
Visiting with your minimally invasive surgeon should address all of these issues. The video-assisted approach is applicable to nearly every situation; not every patient is a candidate for a "scarless" transaxillary (underarm) approach. The safety of minimally invasive surgery has been confirmed in large studies performed in Europe and Asia, where these procedures were initially developed.
How long is recovery time?
Recovery from thyroid or parathyroid procedures depends primarily on the extent of surgery. Parathyroidectomy for single adenoma or partial thyroidectomy typically involves a very brief recovery with minimal pain. Total thyroidectomy or extensive parathyroid exploration will incur a slightly greater recovery.
Minimally invasive procedures can reduce by half the recovery time from conventional thyroid and parathyroid surgery. Most patients return to non-strenuous activity in four to seven days. Totally endoscopic approaches dramatically reduce pain and recovery time. Many patients do not require prescription pain medications at discharge.
What if I live outside of Iowa?
Dr. Wright practices at ENT Clinic of Iowa in Des Moines, Iowa. Arrangements can be made to accommodate patients from out of state or out of the country when preliminary records such as ultrasound reports and pathology reports are made available. Most patients recover suitably for travel within 24-48 hours of surgery.
To schedule a telephone consultation with Dr. Wright, call 1.800.726.8088.
Doesn’t it hurt more to go all the way from the armpit to the thyroid?
No. While it seems like a totally endoscopic approach involves a larger area of operation that would be more painful, in fact is it dramatically less painful. This is because there is a natural seam – or surgical plane – which exists under the skin of the neck and chest. Compared with cutting through muscles and tissues of the neck and retracting strenuously, as with a conventional approach, the totally endoscopic transaxillary approach simply “unzips” this plane and gains immediate access to the thyroid space. There is no retraction whatsoever. Our recent review of our results presented in Edinburgh, Scotland at the British Association of Pediatric Surgeons reveals that totally endoscopic thyroid patients required on average a cumulative total dose of less than 1.5 mg morphine postoperatively; most did not require prescription pain medications at home.
Why is it less painful going through the armpit approach?
While the exact reason hasn’t been scientifically studied, the most likely explanation is simply that no retraction is required and no muscles are divided. The tissue planes are gently and precisely separated and connections to the thyroid released. From the standpoint of tissue manipulation, it is by far the least invasive approach, and this is reflected in the conspicuous paucity of post-operative pain.
Does insurance cover minimally invasive thyroidectomy?
Within the state of Iowa, there is no additional cost for minimally invasive thyroid procedures. For patients travelling from out of state, increased out-of-pocket costs frequently apply. For some insurance plans, this can be substantial. Out of state candidates should check with their individual insurance providers to determine these costs.
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