Patient Information on Minimally Invasive Thyroidectomy

ENT Clinic of Iowa offers extensive experience in the surgical management of thyroid disorders. As neck surgeons, our physicians have unmatched experience in surgery of the neck. When it comes to both thyroid and parathyroid surgery, our surgeons are among the most experienced in the state of Iowa.

Page Resources: Development of minimally invasive thyroid surgery Video-assisted thyroidectomy Totally endoscopic thyroidectomy Side-by-side surgical comparison

Thyroidectomy – the surgical removeal of part or all of the thyroid gland - is indicated for three major reasons, the most common of which is the development of a suspicious lump within the gland. In these cases, initial evaluation typically includes thyroid ultrasound and fine needle biopsy. In some cases, a nuclear radioactive uptake scan is done. Even with these studies, occasionally definitive identification of the lump is not possible. When cancer is suspected, or when the identity of the mass is uncertain, thyroidectomy may be indicated to definitively treat or assess the lump.

Thyroidectomy may also be performed when a large goiter forms and constricts the surrounding structures of the neck. This can cause difficulty swallowing, neck fullness, and a strangulation sensation. Occasionally, a large thyroid can actually push on or deviate the windpipe. In these cases, surgical removal of the thyroid gland may be indicated.

In rare cases, a hyperactive thyroid nodule can form. When this occurs, a single lump in the gland strongly overproduces thyroid hormone, causing hyperthyroidism. When present, surgical removal of this hyperactive nodule is curative of the disease.

In general, patients recover from thyroid surgery very quickly. In most cases, incisions are well-hidden in existing skin creases and are difficult to notice once complete healing has taken place. All surgeons at ENT Clinic of Iowa strive to minimize incision length while maintaining the safety of the procedure. Many patients are candidates for a minimally invasive approach.

Thyroid cancer is an uncommon disease; however, many common thyroid disorders simulate thyroid cancer, and surgical removal of portions of the thyroid gland is frequently necessary for diagnosis. This means that many people undergo surgery for a benign problem and acquire an undesirable scar as a result. Fortunately, techniques now exist to minimize or eliminate incisions for thyroid surgeries.

Development of minimally invasive thyroid surgery

Since the early 1980s, minimally invasive surgery has revolutionized the surgical management of conditions in the chest and abdomen, drastically reducing recovery from invasive procedures and expanding the range of therapeutic interventions.

Some disorders of the head and neck have traditionally required large incisions to gain access to small areas or structures. Examples of this include thyroid surgery for benign nodules, parathyroid surgery, lymph node biopsy and implantation of a vagal nerve stimulator (an anti-seizure implant similar to a pacemaker).

In these cases, disfiguring incisions are made in visible areas of the neck simply for surgical access. In response to this problem, less invasive techniques have been developed and are now in practice around the globe.

Minimally invasive surgery of the neck was first developed for management of thyroid and parathyroid disorders. Since that time, a variety of minimal-access techniques have been developed which accomplish the desired surgical goal. These techniques are currently practiced worldwide, and multiple clinical trials confirming the safety and benefit of these procedures have been performed.

Dr. Wright has been performing video-assisted procedures since 2002. He performs most thyroid and parathyroid surgeries using this technology, minimizing the length of surgical scars. Some thyroid patients are candidates for a scarless, totally endoscopic procedure, which involves the creation of no visible incision. In addition, Dr. Wright has developed a minimally invasive technique for placement of the vagal nerve stimulator which eliminates any scar on the neck.

 

Video-assisted thyroidectomy

The video-assisted surgical technique markedly shortens incision length (typically around one inch vs. three inches with traditional surgery). It also reduces post-operative pain and speeds recovery time.

This technique has been performed thousands of times around the world with consistently safe results comparable to the conventional technique. It does not increase operative time and incurs no increased risk.

Originally developed in Italy, the video-assisted technique has only recently been taught in the United States. A handful of surgeons in this country have been doing this technique for a number of years, including Dr. Wright, who is one of the most experienced surgeons in the United States with this technique.

Totally endoscopic thyroidectomy

A second, more sophisticated variation of minimally invasive thyroidectomy may be an option for some patients. Using special instrumentation and techniques, part or all of the thyroid gland can be removed through small puncture sites in the underarm area, avoiding any incision on the neck whatsoever. Much less pain and much more rapid recovery can be expected with this approach.

The surgeon operates using laparoscopic instruments and supervises the case through endoscope cameras under high magnification. In many cases, the surgeon can see better in this technique than in a conventional open procedure. Only selected patients are suitable for this operative approach, however.

Side-by-side surgical comparison

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