Techniques * Minimally Invasive Thyroid & Parathyroid Surgery

Thyroid and parathyroid surgery become necessary for a variety of reasons. From a surgical standpoint, safely performing these procedures depends on clear visualization of important nearby structures, including nerves and glands. For the past century, this has involved the creation of a large incision. Using advanced techniques, it is now possible to safely perform these procedures endoscopically, minimizing or eliminating incisions, recovery time, and post-operative pain.

Dr. Wright and his team developed this technique and have most experience with this type of surgery in this hemisphere. Most surgical thyroid or parathyroid conditions are suitable for either a totally endoscopic or video-assisted approach.

Major technological developments have emerged in thyroid surgery over the past 10 years, creating a new field of minimally invasive and endoscopic thyroid surgery. The crucial elements facilitating this option are head and neck endoscopic soft-tissue dissection capabilities made possible through the pioneering work of video-assisted surgeons, along with the application of CO2 insufflation to the upper chest and neck. The ability to endoscopically manipulate and dissect tissue in a non-traditional body cavity (potential space) has allowed surgeons to access the thyroid and other neck compartments from distant, non-visible sites such as the axilla or breast. Thus, the capability to perform scarless thyroidectomy or other head and neck procedures has developed.

These procedures can be generally divided into two main categories: video-assisted and totally endoscopic. Video-assisted thyroid surgery involves creating a much smaller neck incision (typically 2-3 cm < 1 inch) compared with the conventional 6-10 cm incision. Using retractors and endoscopes, dissection of the gland is performed. Recovery is shortened, and less pain is experienced. These procedures were pioneered primarily in Italy, where thousands have been performed with equilivalent safety and overall outcomes. Nearly any patient is suitable for this approach. Central neck dissection and early thyroid cancer management is feasible through a mini-incision of this type.

The totally endoscopic technique involves using laparoscopic instruments through axillary puncture sites to operate in the neck. This avoids any neck incision. In addition to the complete avoidance of visible incisions, more rapid recovery and markedly reduced postoperative pain are major benefits to this approach. This approach was originally pioneered in Japan and is now being practiced at selected institutions in Asia and Europe. Dr. Wright has been performing these and similar procedures since 2005 and currently has the largest experience of this type in the country.