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HeadWay - Collaborations lead to innovations

HeadWay Fall 2010

Collaborations lead to innovations

Date: November 30, 2010


The thyroid and parathyroid surgery team is performing transaxillary operations that leave no scar on patients’ necks.
The thyroid and parathyroid surgery team is performing transaxillary operations that leave no scar on patients’ necks.

After finishing his head and neck surgery fellowship at The Johns Hopkins Hospital in 2001, Ralph Tufano decided to stay and join the Head and Neck division, even though they were then performing only a handful of thyroid and parathyroid operations. “I felt like I could really be part of a growing area,” he says, “and make a difference.”

Last year, Tufano, now director of thyroid and parathyroid surgery, and his colleagues performed more than 250 thyroid- and parathyroid-related procedures, an expansive growth he attributes to Johns Hopkins’ interdisciplinary approach. Although endocrinology, general surgery, and otolaryngology–head and neck surgery are separate at many hospitals, physicians from these specialties collaborate here to make sure patients get the best care.

Such close teamwork allows them to develop the best plan to tackle especially difficult procedures, such as reoperations when cancer recurs. These surgeries can be incredibly complex, involving navigation around scar tissue from previous surgery. Tufano notes that the ability of the various specialist teams to pool their expertise is a draw for many cancer patients who need follow-up surgery. “We probably do more reoperative procedures than any other place in the country,” he says.

The close collaboration also allows Johns Hopkins’ thyroid and parathyroid surgeons to offer some unique options to patients here. Recently, head and neck surgeons including Jeremy Richmon and colleagues in the Department of Surgery began performing transaxillary thyroidectomies and parathyroidectomies, with incisions through a patient’s armpit instead of the traditional approach through the neck, which leaves a scar.

“We see the majority of thyroid problems in younger women,” Richmon says, “but sometimes those who are advised to have surgery are really reluctant to follow through because they know they’ll have a visible neck scar.”

The procedure involves inserting into a single armpit incision an endoscope with two cameras, along with three robotic arms for grasping, dissecting and cutting. Functional outcomes for this type of surgery have been shown to be the same as those of an open procedure for selected cases.

Richmon anticipates that it’s just a stepping stone to more innovative “scarless” thyroidectomies and parathyroidectomies. He and Tufano have successfully tested another procedure in cadavers in which they make an incision through the floor of the mouth to insert instruments just behind a patient’s teeth. They now hope to offer this option to patients in the next two years.

Meanwhile, Tufano and his colleagues are working on identifying a series of biomarkers that can predict a thyroid cancer patient’s prognosis. Those with a more favorable prognosis may qualify for less aggressive surgery or even avoid surgery altogether.

With thyroid cancers on the rise, Tufano notes that such innovations have never been more necessary.

“We’re excited to develop these ideas,” he says, “and get new treatments out to patients with thyroid and parathyroid disease.”

To refer a patient, call 410-955-3628.

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