collar incision for thyroidectomy

B, C The recurrent laryngeal nerve (RLN) was identified and then traced. In the absence of contraindications, substernal goiter should be treated with early surgery rather than having it run the risk of acute airway distress, especially in younger patients. However, COT normally requires a long collar incision (usually 5-8 cm in length) on the anterior neck [1]. Have certain genes or a family member with goiters. The recurrent laryngeal nerve provides nerve input to the vocal cords, and is also intimately involved with the thyroid gland. Introduction The standard approach to thyroidectomy is a collar incision via the anterior neck, and the neck scar has always been a source of worry for patients. How helpful the three-dimensional endoscopy or robotic endoscopy to the completion of bilateral (total) thyroidectomy via trans-axillary approach is worth further exploration. Some patients experience a "crawling" sensation in the skin, muscle cramps or headaches. The parathyroid glands control calcium homeostasis within the body. also reported a study concerning the gasless trans-axillary thyroidectomy with the assistance of robots. 1996-2023 MedicineNet, Inc. An Internet Brands company. All authors have no conflicts of interest or financial ties to disclose. Rarely, a surgeon may open the sternum (chest) to remove the goiter. If the patient was taking thyroid hormone before the operation, they should continue taking the same dose unless it was changed by the surgeon. Goiters may be a result of the over or underproduction of the thyroid hormone or the presence of nodules in the thyroid gland. further described gasless endoscopic thyroidectomy through the axillary region, which can effectively avoid the influences of carbon dioxide [8]. Berber E, Bernet V, Fahey TJ 3rd, Kebebew E, Shaha A, Stack BC Jr, et al. Great efforts are made during surgery to identify and preserve this nerve on both side of the thyroid gland. As per the largest study done, the rate of sternotomy is less than 5%, the complication rates are acceptable, and the mortality is less than 1%. Gasless, endoscopic trans-axillary thyroid surgery: our series of the first 51 human cases. The alleviation of the discomfort in the anterior neck area and sternocleidomastoid, and the cosmetic effect of gasless endoscopic trans-axillary thyroid surgery were acceptable. Patients should call their surgeon's office to make a follow up appointment 3 weeks after surgery. Bhargav PR, Kumbhar US, Satyam G, Gayathri KB. This chapter presents historical discussions followed by a series of important guiding principles that serve as fundamental reference points during thyroid and parathyroid surgery incisional design. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. MedicineNet does not provide medical advice, diagnosis or treatment. Incision: A transverse collar incision is usually made 1-2 fingerbreaths above the sternum along the skin crease. Background Since Theodor Kocher reduced the mortality rate of thyroidectomy from the 40% reported by Billroth to 0.2% in 1895, a collar incision with open removal of the thyroid gland is the standard procedure [1, 2]. C, D Step two, sternocleidomastoid muscle (SCM) was dissected longitudinally and the sternal head of SCM was elevated by the retractor to expose the strap muscles. A, An extended low cervical collar incision is used when a lateral neck dissection is indicated. Thus, gasless endoscopic thyroidectomy without the assistance of robots might be more suitable. While the conventional collar incision is widely used, endoscopic thyroidectomy is gradually becoming accepted for thyroid nodule patients with cosmetic needs [2,3,4].Under the premise of oncological effectiveness, endoscopic thyroidectomy can provide a . Endoscopic and robotic thyroidectomy for cancer. Only two patients developed temporary vocal cord paralysis and no patients developed other severe complications. + )&`30^2{[b#nuwUhSr e4vMHCH qOmo.S2:uZN|/L.J. A tube may be left in place to drain fluid and blood. These nerve control the vocal cords. However, bleeding in the neck is potentially life-threatening because as the blood pools, it can push on the windpipe or trachea causing difficulty breathing. WBX and ZYZ drafted the Result, Discussion, and Conclusion sections. Surg Endosc. 2020;34:1891903. The vast majority of patients do not require narcotic pain medications. 79 0 obj <>stream No evidence of recurrence was found during the follow-up period. Thus, the outcome of substernal goiter surgery is usually good. For patients who develop hypertrophic scars, those who develop keloids and persons who want to do everything possible to avoid an incision on the neck, this procedure is possible. The PSSs were 1 (very satisfied), 2 (satisfied), 3 (unsatisfied), or 4 (very unsatisfied) [13]. By contrast, a television commentator with an 11-inch neck (Figure 42-3, A) and a 2-cm follicular neoplasm (Figure 42-3, B) is an ideal candidate for an endoscopic thyroidectomy. If symptoms of hypocalcemia develop, take an extra two Tums Ultra 1000 tablets and if the symptoms do not go away after 30 minutes, call your doctor. Later on, in 1880, Jules Boeckel of Strasbourg introduced the collar incision to thyroid surgery, and this approach was popularized, later on, by Theodor Kocher. The total mean operative time was 141.6 34.4 min (range 95240 min, from anesthetic intubation to leaving the operating room and entering the postanesthetic care unit (PACU)). The operation generally lasts from 2-3 hours. Thyroidectomy incisions have significantly decreased in size since Kocher first popularized his low collar incision in the late 19 th century 4. Kang JB, Kim EY, Park YL, Park CH, Yun JS. 2011;25:135863. It provides a good alternative beyond This suggests that discomfort in the anterior neck area and SCM is obvious shortly after surgery and is relieved over time in most cases. Patients should discuss with their doctors when and if they should restart these medications. In conclusion, these results revealed that gasless, endoscopic trans-axillary thyroidectomy is a feasible surgery type with an acceptable safety profile and cosmetic outcomes in strictly selected patients. UC Irvine was the first institution on the West Coast of the United States to perform this operation. have been classified as minimally invasive. The operation is longer, requires the surgeon operate off a video monitor, and requires assistants to retract the tissues and another assistant to hold the endoscope. We divided the patients into two groups in surgical order to compare the VRSs regarding paralysis of the SCM. J Laparoendosc Adv Surg Tech A. All cases of this complication reported to date have been temporarily, and is related to compression of the brachial plexus from arm positioning during surgery. This will disappear over the next 3 to 6 months. Statistical analyses were conducted using the Students t test and one-way ANOVA through the SPSS 23.0 software. Furthermore, the sensory change and paralysis results from this technique and patients satisfaction with the cosmesis were also studied. a skin incision was made using scalpel, More recently, partly driven by public demand, ever smaller incisions have been utilized (when it can be done safely) in order to improve patient satisfaction, and the procedure is now tailored to the individual condition. Kang SW, Lee SC, Lee SH, Lee KY, Jeong JJ, Lee YS, et al. It is in this position that patients will be in public situations such as dinner parties and cocktail receptions, and it is in this position the suprasternal notch (the depression created by the medial heads of the sternocleidomastoid muscle) can best be seen. What percentage of the human body is water? 202011960). Most patients will feel like they have a sore throat for the first few days after the operation, especially when swallowing. Minimally invasive incisions might be placed in the hollow between the medial heads of the sternocleidomastoid muscle. The system also has tremor filtration and scaling of movements to eliminate tremor and allow very fine microsurgical movements if needed. Hypocalcemia can cause symptoms such as numbness and tingling (especially around the lips and in the hands and feet) as well as cramping and even "locking" of the hands and feet. Kocher himself, however, recognized the logic behind utilizing as small an incision as possible and is quoted as saying thyroidectomy incisions should be as small as possible, as big as necessary, therefore perhaps qualifying him as the first minimally invasive surgeon. Indications for removal of the gland include most types of thyroid cancer, large goiters causing compression of the airway, and Graves disease. Patients with other significant medical issues may be asked to visit with their medical team to obtain a letter of medical clearance. Substernal goiter can be removed through a relatively straightforward collar incision in the lower neck. Standard incisions that are placed too low, spanning this indented suprasternal notch region, may appear asymmetrical and tend to be hypertrophic in their midsegment as opposed to incisions higher, in a more uniform, cylindrical region of the neck. It is often possible for your surgeon to place the incision in an existing skin crease. The surgical drain was removed 2 days after surgery in all cases. Comparison between 3-dimensional and 2-dimensional endoscopic thyroidectomy for benign and malignant lesions: a meta-analysis. The paratracheal lymph nodes are divided into pretracheal, prelaryngeal, and right and left lateral paratracheal lymph nodes. Because of the risk of hypertrophic scarring, we recommend resecting a sliver of skin edge whenever and wherever this is recognized (Figure 42-7). The average blood loss for this operation is less than a tablespoon and the chance of needing a blood transfusion is extremely rare. Another variation of the minimally invasive thyroidectomy is the minimally invasive video-assisted thyroid surgery (MIVAT). When this happens, you can trim the edges or let the glue fall off on its own. Ann Surg Treat Res. that the dissected flap width in trans-axillary approach is significantly wider than conventional thyroidectomy, causing greater trauma, and potentially more severe pain [20]. This work was supported by the National Natural Science Foundation of China (grant No. A 5- to 7-cm arc incision was made along the dermatoglyphic direction, 1-2 cm above the sternal notch. If the seroma is large, the surgeon may drain it with a small needle. Most people will not be able to notice the incision once the redness fades away. Terms of Use. Thyroidectomy for substernal usually includes goiters with minimal extension in the thoracic cavity and those that are present in the mediastinum (the area surrounding the chest cavity ). The middle thyroid vein was then ligated. Compared with conventional approach, it holds the advantages of comparative extensive indications and similar complication rate but achieving a better cosmetic result. Google Scholar. A number of technological advances such as advanced energy devices for hemostasis,1 high-resolution endoscopes for improved visualization,2 and laryngeal nerve monitoring3 have increased the focus on cosmetic outcomes and the pursuit of smaller, well-camouflaged incisions.4 Also emerging are techniques for remote access thyroid and parathyroid surgery.5,6 Conventional surgery remains necessary in many circumstances, such as for large substernal goiters or advanced malignancy, and will remain in the endocrine surgeons armamentarium.
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