Keyhole thyroid surgery without neck scar is a revolution
Talking about open thyroidectomy surgery today seems like a trip down the memory lane. It was an acceptable and classical treatment for thyroid irrespective of lobectomy, removal of a nodule in the thyroid gland or total thyroidectomy. With advances in medical science, minimally invasive surgery has emerged. A long neck scar post thyroid surgery which used to be acceptable is now considered a nightmare.
The thyroid is an organ lying in the neck covered by strap muscles, fat and skin. Any nodularity, growth or swelling of the gland requires investigations. Investigations include ultrasound, thyroid function tests and if needed a needle biopsy called fine needle aspiration cytology. Based on the investigations if the disease needs to be surgically removed there are options to go for an open or a minimally invasive procedure.
Today, individuals tend to prefer cosmetically acceptable surgeries. An open thyroid surgery with a big scar is not considered a procedure of choice. Endoscopic thyroidectomy has taken over open surgery. Multiple approaches for endoscopic thyroidectomy are available as per the expertise of the surgeon. It includes transoral, through axilla or through the breast.
Minimally invasive surgery has been adopted for thyroid since 1996 when Ganger performed the first such surgery. Two decades on, today people talk of improving the technique to reduce the morbidity related to the procedure. The primary rationale for introducing and practising the technique is to achieve a cosmetically better result as well as less scarring of the neck.
Recently, a young female with multi-nodular goiter was operated via endoscopic technique. The operative time was 90 minutes — similar to an open procedure. The planes were better visualised and it was also easier to identify the parathyroid gland as well as the recurrent laryngeal nerve. Post-operatively the patient did well and was discharged the next day in a stable condition. She came for follow up and was happy with the procedure. Her pain did not last long which enabled her to get back to daily routine, just one week after the surgery.
With the advances and establishment in endoscopic surgery for thyroid, the acceptance for the surgical management for thyroid has increased. As more surgeons gain expertise in endoscopic thyroidectomy, life of patients will become easier. It is a safe and cosmetically acceptable procedure where surgeons can assimilate without a long learning curve. Dr Rohit Kumar is the head of
surgery and emergency at International Modern Hospital