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8/10/2019 Thyroidsurgerybymini Incision 110210103359 Phpapp01

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Thyroid

surgery bymini-incision

Rosemary Hard in MD, Joel le Pierre MD,

and George Ferzli MD, FACS

SUNY Downstate

Medical Center

Lutheran

Medical Center


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A review of our method of thyroid

surgery via mini-incision, first

published in JACS (Journal of the

American College of Surgeons, May

2001).

G Ferzli, P Sayad, Z Abdo, R Cacchione Minimally invasive, non-endoscopic thyroid surgery.

J Am Coll SurgMay 2001: 192 (5) 665-668


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An incision is made along a

skin crease high up in the neck.

Superior and inferior

subplatysmal flaps are

developed.


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The superior pole vessels are

approached first, from a medial

to lateral direction, staying close

to the capsule to avoid theexternal branch of the superior

laryngeal nerve

(*Amelita Galli-Curci*,

Julie Andrews?)

* Injury to the Superior Laryngeal Branch of the Vagus During Thyroidectomy: Lesson or Myth? Peter F. Crookes,

MD, FACS and James A. Recabaren, MD, FACS From the Department of Surgery, University of Southern California KeckSchool of Medicine, Los Angeles, California


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Delivery through the wound, of the upper

pole of the thyroid with medial rotation, willallow a view of the laryngotracheal

junction.


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Rt. recurrent laryngeal nerve

Tubercle of Zuckerkandl

Rt. upper parathyroid gland

At the laryngotracheal

junction, identify thefollowing structures:


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Middle thyroid veinligated and divided


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The inferior pole vessels

are divided

If total thyroidectomy, repeat

steps on left side

Free trachea from thyroid by

dividing ligament of Berry

Ligament of Berry


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Thyroid gland

is delivered

easilythrough the

wound


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PATIENTS

264 thyroid surgeries on

256 patients

55 men and 201 women Age17 to 95 years (48)


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PREOP DIAGNOSIS

Mass or nodule = 176

Goiter = 74

Hyperthyroiditis = 6


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Type of procedures:

5 nodulectomies 78 R lobectomies

65 L lobectomies

30 near total

86 total thyroidectomies

Lymph node dissection 6 patients

Length of incision:

2 cm. = 52

2.5 cm. = 32

3 cm. = 68 4 cm. = 98

> 4 cm. = 14

Total 264

Of the 256 patients, 8 who initially underwent

unilateral thyroid lobectomy subsequently requiredresection of the contralateral lobe (completion

thyroidectomy using the same incision)


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OR TIME27 164 (48.59)

(dropped from an average of 76 in

2001 in the first 89 patients)

HOSPITAL STAYOutpatient = 26 patients

23 hours = 210 patients

Two days = 18 patients

> Two days = 2 patients


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COMPLICATIONS

Arrhythmia = 1 patient

Hematoma (reop) = 1 patient

(R thyroid)

Open wound (near total) = 1 patient

Inadvertent

parathyroidectomy = 3 patients

Hypocalcemia = 3 patients(2 requiring readmission)

Nerve injury Recurrent laryngeal = 3 (2 transient, 1 permanent)


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POST OPERATIVE PATHOLOGY

WEIGHT 4530 gm. (50.05)

PATHOLOGIESFollicular adenomas 68

Papillary carcinomas 53

Multinodular goiters 38

Colloid nodules 11

Hashimotos thyroiditis 25Mixed papillary-follicular carcinomas 4

Follicular carcinoma 10

Lymphoma 1

Graves disease 2

Medullary carcinoma 2Chronic lymphocytic thyroiditis 2

Hurtle cell cancer 6

Nodular hyperplasia 34

TOTAL 256


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CONCLUSION

Thyroid surgery using mini-incision is

feasible and safe

Done on an out-patient basis

Can be attempted on any thyroid pathology

Can be performed under local anesthesia

Compared to endoscopic thyroid surgery,

it has a shorter operative time, shorter

hospital stay, comparable cosmetic resultsand no complication related to neck insufflation

Completion thyroidectomy, when required, can be performedthrough the same incision

It has an excellent cosmetic result

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