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15-06-2006 | Thyroid | Article

Minimally invasive thyroidectomy improves outcomes

Abstract

Free abstract

Scientists have discovered that thyroidectomy can be performed using a new surgical method that involves an incision about half the length used for traditional surgery, combined with ultrasonic technology.

This minimally invasive approach is safe, likely speeds wound healing, and results in a superior cosmetic outcome, the authors say in the journal The Laryngoscope.

For their study, David Terris, from the Medical Center of Georgia in Augusta, USA, and colleagues studied data from 44 patients with cancerous or benign thyroid disease who underwent surgery at their center. The participants were aged an average of 44 years and 40 of them were female.

In performing a standard thyroidectomy, a 3-4 inch horizontal incision is made at the base of the neck to dissect out the thyroid. This approach remains the best option for some patients who have had previous surgery or have an extremely enlarged thyroid.

However, most patients – 65% of the 44 patients in the present study – likely can benefit from a smaller, more direct approach, involving an incision of only 1-2 inches, the investigators note.

They add that working through the smaller space increases surgery time about 20-30%, but that this was not a deterrent for the patients.

Using the minimally invasive approach, the surgeons made a small incision, then used tiny video cameras and endoscopes to enable removal of the thyroid through the incision.

Reduced tissue trauma in this technique means less chance of postoperative drainage from the site, allowing patients to go home the same day or spend one night in the hospital compared to 2 to 3 days with the older technique, Terris and co-workers stress.

None of the patients selected for the new approach had to be converted to conventional thyroidectomy; one patient developed a mildly thick scar that responded to treatment.

"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," said Terris.

"This approach is evolving but is an appropriate addition to the practice of the modern endocrine surgeon," the team writes.

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