Dr. Kuppersmith, ENT, Specializing in Thyroidectomies, A New Type Of Surgery For Thyroid Patients
It is dreadful enough that you make me feel bad when you are not reliably making the right amount of hormone, BUT when my doctor tells me that you have a growth that may potentially be cancerous and she wants me to consult with a SURGEON; you are trying to push me over the edge.
New Options for Thyroid Surgery: MIVAT and Robot-assisted Thyroid Surgery
The most common reason patients are referred for a surgical consultation is either to remove a known thyroid cancer or to remove a mass that is suspicious for cancer. Less commonly, patients have surgery for an enlarged thyroid that causes compression on the airway and/or esophagus causing breathing difficultly and/or swallowing problems. Occasionally, thyroid surgery is also performed for Grave’s disease that does not respond well to medications or as an alternative to radioactive iodine.
The reason why this might be important to you is that thyroid nodules are very common. Studies have shown that thyroid nodules have been detected in 19-67% of randomly selected individuals by ultrasound. While nodules are common, fortunately cancer is, uncommon. It is estimated that 5-15% of nodules are cancerous. Several recent studies suggest that thyroid cancer rates are on the rise. Fortunately, most thyroid cancers are amenable to treatment and have a good prognosis. (There are some rare cases that prove to be the exception.)
Some risk factors for thyroid nodules include being female, advancing age, history of pregnancy, and radiation exposure. Risk factors for thyroid cancer include family history of thyroid cancer (medullary thyroid carcinoma), radiation exposure, Hashimoto’s thyroiditis (lymphoma), and the presence of a thyroid mass in a child or in male patients.
For many years, thyroid surgery had been performed through a horizontal incision in the lower collar. The length of this incision can vary from 4-8 cm in length. Most people are familiar with this incision and with time most fade away and are not noticeable. (Of course, there are exceptions.)
The typical risks of thyroid surgery include injury to the superior or recurrent laryngeal nerve which can result in temporary or permanent hoarseness or airway obstruction and injury to the parathyroid glands, which can result in temporary or permanent low calcium levels. In patients, who undergo total thyroidectomy, lifelong thyroid supplementation will be necessary. In patients, who have a thyroid lobectomy (removal of half of the thyroid) and do not require thyroid medication before surgery, approximately 20% will eventually need thyroid medications.
Recent advances have provided surgeons and patients with new possibilities for improving thyroid surgery outcomes in terms of reducing the risks and improving the cosmetic results of thyroid surgery.
One advance, Minimally-Invasive Video Assisted Thyroidectomy (MIVAT), was developed in Italy. MIVAT allows a surgeon to remove the thyroid through a smaller incision (1.5-4 cm) in the location of a typical thyroid incision. This is accomplished through the use of an endoscope, which provides a two-dimensional image, allowing the surgeon to safely identify the nerves and parathyroid while removing the thyroid.
Another advance is the application of robotic instrumentation to thyroid surgery. The most commonly used technique was developed in Seoul, Korea where they have performed more than 1500 cases and have shown the procedure to be safe and feasible. By approaching the thyroid through an incision under the arm, this procedure can be described as a “remote accessÃ¢â‚¬ rather than “minimally invasive…
From the patient’s perspective, Robot-assisted Thyroid Surgery allows the thyroid to be removed through an incision in the armpit, eliminating the incision in the neck. For some patients, this is an important consideration. The use of the daVinci Surgical System provides the surgeon with a three-dimensional high-definition view of the surgical field, magnifying important structures including the nerves and parathyroids. It also allows the surgeon to control three instruments, instead of two, with improved precision and manual dexterity.
Not all patients that need surgery are candidates for MIVAT or Robot-assisted Thyroid Surgery. The size of the thyroid, presence of thyroiditis, and other anatomic factors may determine whether a patient is a candidate for one of these procedures. Additionally, as these techniques are relatively new, they may not be available in all cities around the US.
As in the case of any surgery, it is important to do your research and understand the different options that you might have, including the risks and benefits. You should choose a surgeon who has significant experience with the procedure you need and you should feel comfortable asking the surgeon about your concerns.
Questions for us from Dr. Kuppersmith:
What are your biggest concerns about having surgery? If you haven’t had surgery, are you concerned about having a neck scar? If you have had surgery already, how was your surgical experience? How was your recovery? What did you like about your surgeon? How could your surgeon have been more helpful? What suggestions do you have for other patients who may have surgery? What do you think about your scar? How long did it take to get your thyroid hormone levels correct after surgery to where you were feeling good?
Tags: Dr. Ron Kuppersmith ENT, enlarged thyroid removal, graves disease patients, Hashimotos patients, MIVAT, New Options for Thyroid Surgery, Robot-assisted Thyroid Surgery, thyroid cancer patients, thyroid extraction, Thyroidectomies