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A new study shows an incision half the
length used for traditional surgery works just as well in removing diseased
thyroids.
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An incision about half the length used for traditional
surgery works just as well in removing diseased thyroids,
researchers have found.
This minimally invasive approach is safe, likely speeds wound
healing and has a superior cosmetic result, according to findings
published in the June issue of Laryngoscope.
The study looked at 44 patients with cancerous or benign thyroid
disease who had surgery between September 2003 and May 2004 at
Medical College of Georgia Medical Center or the Veterans Affairs
Medical Center in Augusta.
"This is a very straightforward approach in skilled hands that
allows us to use smaller incisions while still safely identifying
important structures in the area, which are the nerves to the voice
box and the parathyroid glands," says Dr. David J. Terris, Porubsky
Professor and chair of the MCG Department of Otolaryngology - Head
and Neck Surgery and lead author on the study.
This approach incorporates various techniques to reduce the
typical incision size across the base of the neck ? from about three
to four inches to one to two inches ? while still enabling removal
of all or part of the peach-sized gland that controls metabolism.
Growths on this gland can cause jitters and weight loss.
"We use retractors to get exposure and use telescopes and other
laparoscopic instruments that can fit through a small incision then
we work off the video screen," says Dr. Terris. "I send many
patients home the day of surgery because it's so much less
invasive."
To access the thyroid, most otolaryngologists make a horizontal
incision at the base of neck, called a transverse cervical collar
incision, move the muscles and dissect out the thyroid. This
approach remains the best option for some patients who have had
previous surgery or have an extremely enlarged thyroid.
But most patients ? 65 percent of the 44 patients in the study ?
likely can benefit from a smaller, more direct approach, Dr. Terris
says. He notes that working through the smaller space increases
surgery time about 20-30 percent, but that has not been a deterrent
for his patients.
The minimally invasive approach includes a smaller incision,
ligating blood vessels as needed, then cutting through the strap
muscles ? called the Sofferman technique ? to directly access the
thyroid. Surgeons use tiny video cameras and endoscopes to work
through the incision. Afterward, the strap muscles are repaired and
the incision closed with medical-grade glue. Reduced tissue trauma
means less chance of postoperative drainage from the site. Patients
may go home the same day or spend one night in the hospital compared
to two to three days with the older technique.
None of the patients selected for the minimally invasive approach
had to be converted to conventional thyroidectomy. One of the
minimally invasive patients developed a mildly thick scar that
responded to treatment.
"It works great," says Dr. Terris. "It's really revolutionized
how we manage these patients. The biggest thing is that we are doing
this typically on young women. They tend to care the most about what
their incision is going to look like." Women are more likely than
men to develop nodules and thyroid cancer; 31 of the 44 study
patients were women, Dr. Terris says.
That reality helped inspire his pursuit of less invasive options.
"This approach is evolving but is an appropriate addition to the
practice of the modern endocrine surgeon," Dr. Terris and his
colleagues write.
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