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Physicians are providing thyroid cancer patients with new options for less invasive procedures that can reduce or eliminate the scar left behind after thyroid cancer surgery.
Traditional thyroid cancer treatments involve excising the entire thyroid gland, or sections of it, to eliminate the cancer and minimize the risk of tumor recurrence. This typically requires a three to five inch incision at the base of the neck to remove the butterfly-shaped thyroid that spans across both sides of the lower throat just below the “adam’s apple.”
Using techniques generally applied for facial cosmetic surgery or new high-tech robotic instruments that minimize trauma to surgical sites are two ways that surgeons can now treat thyroid cancer with minimal to no scarring.
Most patients with thyroid cancer are concerned with the cosmetic end result, especially women who are more than three to four times more likely to get thyroid cancer than men, explains Dr. David Terris from the Medical College of Georgia Department of Otolaryngology-Head and Neck Surgery.
Dr. Terris found that simply marking incision sites while the patient is sitting so that the scar blends into the natural folds of the neck improves the aesthetic outcome of a thyroid surgery. "You want the incision to be in a location that corresponds to a cosmetically favorable area when you are upright at a dinner party, not stretched out on an operating room table," says Dr. Terris in a Science Daily article.
He limits the size of the opening in the skin as much as possible and the separation of muscle and underlying tissue during surgery to minimize trauma and to promote healing. Dr. Terris also employs clinical-grade glues to seal the suture line to create a finer and less obvious scar than the “railroad-tracking” left by traditional sutures or staples.
A dramatic technical improvement toward less invasive surgery for thyroid cancer involves the use of robotics, or computer-assisted surgical systems (CAS). This approach was developed over the past decade for various types of surgeries and recently has been applied to thyroidectomies.
Surgeons at the University of Illinois Medical Center at Chicago report that they can remove the entire thyroid without any visible scar on the neck. The surgeons used a robotic-armed instrument with endoscopic cameras to delicately guide them through two small openings under the patient’s arm and in the chest to excise the thyroid without cutting into the neck region.
"The cosmetic and psychological benefits to patients are evident immediately," said Dr. Pier Cristoforo Giulianotti, the Lloyd M. Nyhus Professor of Surgery at UIC. "Young patients in particular are often concerned about a large visible scar and this technique provides an alternative to traditional surgery."
Giulianotti has also performed robotic-assisted parathyroidectomy surgery to remove the tiny parathyroid glands located behind or near the larger thyroid gland. Robotic surgeries require highly trained surgeons at specialized medical institutions, currently take more time than traditional surgeries and generally are more expensive.
As more physicians become experienced in the techniques and equipment costs decline to allow more medical facilities access to CAS, robotic surgeries will likely become more common for thyroid cancer patients and others.
Article Links:
University of Illinois information, 2009. “Thyroid Surgery Performed Without Neck Incision, Scar,” http://uillinoismedcenter.org/content.cfm/no_scar
Science Daily article, 2007. “Surgery Techniques Enhance Thyroid Surgery Results,”http://www.sciencedaily.com/releases/2007/07/070709111342.htm
Related Links:
Bonsor, K., and Strickland, J., 2008. “How Robotic Surgery Will Work, “ How Stuff Works http://science.howstuffworks.com/robotic-surgery1.htm