For Thyroidectomies, Leave No Scar Behind
Date: December 12, 2012
For patients with thyroid nodules of indeterminate behavior or hyperfunctional parathyroid glands, surgery to remove these glands can be life-changing in a positive way. But this treatment can be life-changing in another, undesirable way: traditional surgery leaves a neck scar that may be noticeable.
For young women, a population in which thyroid tumors are being diagnosed at an increasing rate, the usual surgical approach to remove these tumors leaves a scar that provides a visible reminder of an experience that most patients would rather forget. These factors that can deter some patients from receiving the treatments they need, says head and neck endocrine surgeon Ralph Tufano.
“Particularly for young women,” Tufano explains, “there’s no skin crease in the neck to hide the incision. Knowing they’ll be left with that neck scar leaves a few patients on the fence about whether to come in for surgery.”
That’s why Tufano and his colleagues are now offering a new option for patients considering a thyroidectomy or parathyroidectomy: robotic surgery through the same type of incision typically used for a facelift.
According to Tufano’s colleague Jeremy Richmon, it’s an approach already familiar to surgeons within the department. By making an incision that goes behind the earlobe and curves beyond the hairline, they both hide the resulting scar and maintain the surgical robot's easy access to the thyroid and parathyroid.
Tufano, Richmon, and surgeons Martha Zeiger and Jason Prescott in the Department of Surgery create the initial incision using the same approach that facial plastic surgeons would use to perform a facelift. They then elevate the soft tissue of the neck and hold it in place using retractors, creating a tunnel to the thyroid and parathyroid. It’s through this tunnel that they insert the robotic instruments, allowing them to resect either organ, even though both are far from the original incision.
The only substantial difference between this approach and the traditional one is the lack of a visible cervical scar, Richmon says. All other results are comparable with traditional surgery.
“Recovery is about the same between the two procedures,” he explains. “Most patients stay just overnight and go home the next morning. Pain is minimal, and patients are walking, talking and eating the same night as their surgery takes place.”
Richmon notes that the procedure has become a growing part of their practice. Hopkins became the second medical center to offer this type of thyroidectomy—one of only a handful around the country since its development at the Georgia Health Sciences Center in Augusta.
Hopkins is now exploring additional ways to perform thyroidectomies and parathyroidectomies, with a transoral approach in the works. “We’re ultimately looking at approaches that will lead to the expansion of the indications for robotic thyroid and parathyroid surgery,” Tufano says.
Learn more about thyroid and parathyroid conditions from the Johns Hopkins Department of Otolaryngology-Head and Neck Surgery.