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Minimally Invasive Thyroidectomy
Minimally Invasive Parathyroidectomy
Parotidectomy

Minimally Invasive Thyroid Surgery

This surgical technique is used to minimize the surgical incision used to remove the thyroid lobe or entire gland. Traditional thyroid surgery is characterized by an 8 to 10 cm (4 inch) incision made in the neck. Reducing the size of the incision to 4 cm or less results in much less scarring, reduced postoperative pain, and less time to heal. An endoscope can be used to assist in removal of the gland. This procedure is called Minimally Invasive Video-Assisted Thyroidectomy. Another benefit of a minimally invasive thyroidectomy is no suction drainage tubes (drain tubes for short) are needed. Patients are able to go home the same day when only one lobe of the gland is removed. When the entire gland (thyroidectomy) is removed, the patient may stay in the hospital overnight. By not using a “drain tube”, patients forgo the uncomfortable removal of the tube as well as having to take care of it while it is in the neck. There is also no unsightly scar from where the tube was sticking out from the neck. Patients who have very large nodules (>5cm) or a goiter, may need to have their incision slightly larger (5 to 6cm). However, they also do not need surgical drainage tubes.

The incision is closed with sutures underneath the skin, so no sutures are needed to be removed after surgery. At your first postoperative appointment (usually 1 week later), you are examined and given instructions on further care. Since there are no sutures to be removed and no drains to take out, this appointment is easy and “pain free”. At one week post-op, you may begin to place vaseline onto the incision site twice daily and clean gently in the shower. Once the incision is healed, sunblock or sunscreen will be needed daily for 6 to 12 months to keep the area from becoming darkly pigmented. Massaging the wound daily and/or applying silicone sheeting may help the scar become less noticeable.

After surgery, a cold pack to the neck along with rest and relaxation allow for a comfortable recovery. Patients are often back to normal daily activities in 3 to 5 days. Heavy lifting and exercise should wait for 10 to 14 days. Most are back to work within 5 to 7 days or less after surgery.

Who Needs Thyroid Surgery?

Patients who have thyroid cancer, nodules suspicious for cancer, enlarging benign nodules, toxic nodules, symptomatic goiter (trouble swallowing or breathing), or Grave’s disease where radioactive iodine is not an option or was unsuccessful.

Anyone who has a nodule that is 1 cm or larger should have this nodule evaluated with a fine needle biopsy or fine needle aspiration (FNA) under ultrasonic visualization. Many endocrinologists do this in their offices today. If the nodule is cancerous, suspicious for cancer, or inconclusive; then thyroid lobectomy is indicated. If cancer is present, the entire gland (total thyroidectomy) is removed. Patients who have benign nodules that are growing may need that lobe removed. Patients who have nodules in both lobes that are growing may need the entire gland removed. Your endocrinologist or ENT doctor (thyroid surgeon) will advise you as to what the best next step is. Patients who are diagnosed with nodules that are less than 1 cm will have a follow-up ultrasound (U/S) in 6 months to determine if the nodule is growing. Patients who have a negative FNA will get a repeat U/S in 6 months. If the nodule is growing or suspicious for cancer a repeat FNA can be performed or the nodule removed (thyroid lobectomy).

Thyroid Q & A

Q: How prevalent is thyroid disease and thyroid cancer among men?

A: Approximately 6,500 men will develop thyroid cancer in the United States this year alone. Of the men who are found to have a thyroid nodule, approximately 10 percent of these will be cancer. All thyroid nodules greater than 1 centimeter should be evaluated for the presence of cancer.

Q: What are the symptoms of thyroid disease?

A: Occasionally, one may feel like they have a lump in their throat. Any “growth” in the neck should be evaluated by an ENT for the presence of cancer.

Q: Is surgery the recommended treatment option for thyroid cancer?

A: Surgery is the only available cure for the most common types of thyroid cancer. Other treatments for cancer are considered adjuvant, or I addition to surgery. Patients may have surgery because:

A nodule is growing or symptomatic- visible to others, bothersome when swallowing or pressing on one’s trachea
A needle biopsy is inconclusive
For diagnostic reasons when the patient chooses not to have a needle biopsy.

When surgery fails to reveal cancer, only the thyroid lobe with the nodule is removed. This procedure is known as a thyroid lobectomy as opposed to total thyroidectomy. Patients who have a thyroid lobectomy often return home from the hospital the same day. Those who have a total thyroidectomy – the procedure of choice when cancer is found- may stay overnight to have their calcium levels monitored. While some surgeons may place drain tubes in the neck after surgery, many no longer do this routinely. Thyroid surgery today, with the exception of masses greater than 5 centimeters, is often performed in a minimally invasive way through incisions 4 centimeters or less. Some surgeons are also using endoscopes in surgery to allow for smaller incisions. These advancements in technique allow for faster and easier recoveries.

Q: What is the impact long-term if the thyroid has to be removed?

A: The impact of the removal of one’s thyroid over time is that he/she will need to take a daily thyroid replacement hormone.

Q: Why should someone choose USMD at Fort Worth if surgery is required?

A: Primarily because of the level of skill and ability of the surgeons who operate there. The staff, anesthesiologist and facilities are all outstanding.

Click here to read an article on thyroid written by Dr. Trimble

Minimally Invasive Parathyroidectomy

The parathyroid glands are small pea-sized shaped glands that are in close proximity to the thyroid gland and control calcium levels in the blood. The most common abnormality of the parathyroid glands is adenoma. A parathyroid adenoma can cause the calcium levels to be elevated. Patients may be asymptomatic or may suffer from numerous symptoms. Symptoms include nausea and vomiting, loss of appetite, excessive thirst, frequent urination, constipation, abdominal pain, muscle weakness, muscle and joint aches, confusion, lethargy, and fatigue. More commonly, patients may suffer from recurrent kidney stones, or be at risk for osteoporosis. Most patients are diagnosed after routine blood testing reveals an elevated blood calcium level. Next, testing for an elevated parathyroid hormone (PTH) level will help to confirm diagnosis.

Minimally invasive parathyroid surgery is made possible by being able to locate the site of the parathyroid tumor prior to surgery. Tumor localization is made by ultrasound and/or nuclear imaging (sestamibi scan). Once the tumor is localized, removal may be accomplished through an incision as small as 2.5cm (1 inch). Surgery is typically less than 1 hour and patients may go home the same day. No drain tubes are necessary. Recovery and aftercare are similar to that of minimally invasive thyroid surgery.

Parotidectomy

Located in front of the ears, the parotid glands are one of the body’s major salivary glands. They extend to the area beneath the earlobe along the lower border of the jawbone. Of all the salivary glands, about 80 percent of all tumors are found in the parotid glands. Most parotid gland tumors are noncancerous. Parotidectomy is the surgical removal of a parotid gland. The paratoid gland is typically removed because of a tumor, a chronic infection, or a blocked saliva gland. A number of tumors can develop in the parotid gland. Many of these are tumors that have spread from other areas of the body, entering the parotid gland through the lymphatic system. Among the tumors seen in the parotid gland are lymphoma, melanoma, and squamous cell carcinoma.

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Head & Neck Surgery

Minimally Invasive Thyroid Surgery

Thyroid Q & A

Minimally Invasive Parathyroidectomy

Parotidectomy