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Thyroid Surgery by Mini-incision
 

Thyroid Surgery by Mini-incision

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    Thyroid Surgery by Mini-incision Thyroid Surgery by Mini-incision Presentation Transcript

    • Thyroid surgery by mini-incision Rosemary Hardin MD, Joelle Pierre MD, and George Ferzli MD, FACS SUNY Downstate Medical Center Lutheran Medical Center
      • A review of our method of thyroid
      • surgery via mini-incision, first
      • published in JACS (Journal of the
      • American College of Surgeons, May
      • 2001).
      G Ferzli, P Sayad, Z Abdo, R Cacchione Minimally invasive, non-endoscopic thyroid surgery. J Am Coll Surg May 2001: 192 (5) 665-668
      • An incision is made along a
      • skin crease high up in the neck.
      Superior and inferior subplatysmal flaps are developed.
    •  
    •  
      • The superior pole vessels are
      • approached first, from a medial
      • to lateral direction, staying close
      • to the capsule to avoid the
      • external branch of the superior
      • laryngeal nerve
      • (*Amelita Galli-Curci*,
      • Julie Andrews?)
      * Injury to the Superior Laryngeal Branch of the Vagus During Thyroidectomy: Lesson or Myth? Peter F. Crookes, MD, FACS and James A. Recabaren, MD, FACS From the Department of Surgery, University of Southern California Keck School of Medicine, Los Angeles, California
    •  
    • Delivery through the wound, of the upper pole of the thyroid with medial rotation, will allow a view of the laryngotracheal junction.
    • Rt. recurrent laryngeal nerve Tubercle of Zuckerkandl Rt. upper parathyroid gland At the laryngotracheal junction, identify the following structures:
    •  
      • Middle thyroid vein
      • ligated and divided
    • The inferior pole vessels are divided If total thyroidectomy, repeat steps on left side Free trachea from thyroid by dividing ligament of Berry Ligament of Berry
    • Thyroid gland is delivered easily through the wound
    •  
    • PATIENTS
      • 264 thyroid surgeries on 256 patients
      • 55 men and 201 women
      • Age – 17 to 95 years (48)
    • PREOP DIAGNOSIS
      • Mass or nodule = 176
      • Goiter = 74
      • Hyperthyroiditis = 6
      • Type of procedures:
        • 5 nodulectomies
        • 78 R lobectomies
        • 65 L lobectomies
        • 30 near total
        • 86 total thyroidectomies
      • Lymph node dissection
        • 6 patients
      • Length of incision:
        • 2 cm. = 52
        • 2.5 cm. = 32
        • 3 cm. = 68
        • 4 cm. = 98
        • > 4 cm. = 14
      Total 264 Of the 256 patients, 8 who initially underwent unilateral thyroid lobectomy subsequently required resection of the contralateral lobe (completion thyroidectomy using the same incision)
      • OR TIME
      • 27’ – 164’ (48.59’)
      • (dropped from an average of 76’ in
      • 2001 in the first 89 patients)
      • HOSPITAL STAY
      • Outpatient = 26 patients
      • 23 hours = 210 patients
      • Two days = 18 patients
      • > Two days = 2 patients
    • COMPLICATIONS
      • Arrhythmia = 1 patient
      • Hematoma (reop) = 1 patient
      • (R thyroid)
      • Open wound (near total) = 1 patient
      • Inadvertent
      • parathyroidectomy = 3 patients
      • Hypocalcemia = 3 patients
      • (2 requiring readmission)
      • Nerve injury
        • Recurrent laryngeal = 3 (2 transient, 1 permanent)
    • POST OPERATIVE PATHOLOGY
      • WEIGHT 4–530 gm. (50.05)
      • PATHOLOGIES
      • Follicular adenomas 68
      • Papillary carcinomas 53
      • Multinodular goiters 38
      • Colloid nodules 11
      • Hashimoto’s thyroiditis 25
      • Mixed papillary-follicular carcinomas 4
      • Follicular carcinoma 10
      • Lymphoma 1
      • Grave’s disease 2
      • Medullary carcinoma 2
      • Chronic lymphocytic thyroiditis 2
      • Hurtle cell cancer 6
      • Nodular hyperplasia 34
      • TOTAL 256
    • CONCLUSION
      • Thyroid surgery using mini-incision is
      • feasible and safe
      • Done on an out-patient basis
      • Can be attempted on any thyroid pathology
      • Can be performed under local anesthesia
      • Compared to endoscopic thyroid surgery,
      • it has a shorter operative time, shorter
      • hospital stay, comparable cosmetic results
      • and no complication related to neck insufflation
      • Completion thyroidectomy, when required, can be performed through the same incision
      • It has an excellent cosmetic result