Scarless Thyroidectomy and Parathyroidectomy

Dr. Shivaprasad Giliyar Srinivasa, Consultant – General & GI Surgery, Aster RV Hospital

Endoscopic thyroidectomy and parathyroidectomy are advanced surgical procedures performed through tiny cuts, unlike conventional open surgery, which requires a large incision on the neck. The exceptional advantage of endoscopic surgery is that it completely avoids the formation of an unsightly and unpleasing scar on the neck. Although many people, including doctors hesitate to adopt these newer approaches due to concerns about nerve injury and voice loss, but it is now possible to safely remove these glands safely with magnified 3D vision system, cutting-edge instruments, a nerve monitoring system and great surgical skill.

A Little about the Thyroid and Parathyroid Glands:

The thyroid gland is located at the centre of neck, superficial to trachea and deep to skin and strap muscle layer. The Thyroid gland has two lobes connected by isthmus, giving it a butterfly in shape. The parathyroid glands four in number, are located at the upper and lower pole of each thyroid lobe.

The neck is an anatomically highly complex area as it serves as bridge between the brain and rest of the body, carrying many vital structures such as nerves, arteries, veins, food pipe and wind pipe. Since the thyroid and parathyroid glands are adjacent to these vital structures any surgery involving them requires the surgeon to place large incision while ensuring the safety of these crucial structure.

Conditions which warrant surgery:

• Benign thyroid nodule
• Cystic lesions of thyroid
• Papillary and Follicular cancers without any lymph node involvement
• Parathyroid adenoma
• Multinodular goitre
• Grave’s disease

What do we do in scarless endoscopic surgery

There are several approaches to access the thyroid and parathyroid glands such as Trans oral, post auricular, Trans axillary, Sternal, breast-axillary. However most commonly adopted approach is breast – axillary, which is widely practised and it is considered safe.

In this approach three tiny incisions are made- 2 near the axilla and 1 at nipple areolar region to avoid any scar on the neck. A camera is inserted in one port, while other 2 ports are used for surgical instruments. A tunnel is created with the help of CO2 gas to develop subcutaneous plane. The gland is carefully dissected, separated from muscles, trachea, oesophagus, carotid artery, jugular vein and strap muscle safeguarding recurrent laryngeal nerve and then removed through axillary port.

Advantages of this procedure?

1. The most significant advantage is that, there absolutely no visible scar on neck. The common question “what surgery happened your neck?” can be emotionally distressing, especially for young women who are conscious of their appearance. Endoscopic scarless surgery eliminates visible scarring, ensuring that no one knows the patient has undergone surgery.
2. Less post-operative pain
3. No difficulty in swallowing after surgery
4. No restriction in neck movement
5. Early removal of drain tube
6. Faster recovery
7. Early discharge from hospital