What is it?

Thyroidectomies using the open method are effective, well-tolerated and safe but involve transverse incision on the neck measuring 7–10 cm in length. Thyroid disorders are more common in women and they find these scars uncomfortable and cosmetically unacceptable.. Hence, minimal access approaches are playing an ever increasing role in neck surgery as they result in a reduction in size or elimination of the scar on the neck. (3)

Endoscopic thyroidectomy (ET) is a demanding surgical technique in which dissection of the gland is entirely performed with an endoscope. It is minimally invasive, using an extracervical access (chest wall, breast, or axillary). (4), (6) The scars produced are hidden beneath the clothes of the patient offering a cosmetic advantage. (3) It is performed via the precordial approach leaves no scarring of the neck, and thus provided excellent results from a cosmetic viewpoint. (2), (7) It is a safe and effective technique in the hands of an appropriately trained surgeon. The patients get a cosmetic benefit without any morbidity. (3)

Why it's done?

Thyroidectomy is the removal of all or part of your thyroid gland. Thyroidectomy is used to treat thyroid disorders, such as cancer, noncancerous enlargement of the thyroid (goiter) and overactive thyroid (hyperthyroidism). (1)

How is it done?

Endoscopic thyroidectomy via axillary approach combines the advantages of minimal access techniques. Inspite the reduced size of skin incision, precise anatomic details are observed through a greatly magnified view using an endoscopic camera. (3)

Preparation

You will have general anesthesia (asleep and pain-free) for this surgery.

Techniques (3)

1. Axillary Approach

The axillary approach can be used for large thyroid lesion but do not extend contralaterally. The patient is in supine position. Three 5-mm incisions are placed below the anterior axillary line equidistant apart or one 30-mm incision is made for a 12-mm and 5-mm trocar, apart from the third trocar (5 mm). A scope or flexible laparoscope with CO2 insufflation at 4–9 mmHg pressure is introduced before starting sharp scissor dissection to dissect an avascular plane between platysma and pectoralis major muscle. Harmonic scalpel and clips are used for division. A retrieval bag is used for extraction of the gland through the axilla. All incisions are hidden in the axillary fossa.

2. Breast Approach

The breast approach allows bilateral dissection. On both upper circumareolar areas a trocar is inserted. The third port (5 mm) can be inserted 3 cm below the clavicle on the side of the thyroid mass or parasternal at the level of the nipple or in the axilla.  A bilateral axillo-breast approach has been developed to obtain optimal visualization of both lobes especially for total thyroidectomy in which the third and fourth port are inserted in left and right axilla. The specimen is retrieved through the 12-mm breast ports. Depending on port placement, there are scars parasternal, perimammillary, and/or axillary.

3. Chest Wall Approach

The chest wall approach is an extra cervical approach favored for bilateral thyroid dissection. A 30-mm skin incision is made below the inferior border of the clavicle on the side of the lesion. A 12-mm trocar is introduced for a flexible laparoscope. Dissection of the gland is performed with ultracision. The specimen is retrieved in a bag through the 3-cm subclavicular incision, leaving no scar in the neck.

Risks

Thyroidectomy is generally a safe procedure. But as with any surgery, thyroidectomy carries a risk of complications.

Potential complications include:

  • Bleeding
  • Airway obstruction caused by bleeding
  • Hoarse or weak voice due to nerve contusion
  • Damage to the four small glands located behind your thyroid (parathyroid glands), which can lead to hypoparathyroidism, resulting in abnormally low calcium levels in your blood and bones and an increased amount of phosphorus in your blood.(1)

Additional information