Minimally invasive thyroid surgery is performed by experienced thyroid surgeons Dr. Jeremy Watkins, Dr. Brad McIntyre and Dr. Sean Callahan at the Fort Worth Thyroid Center. The most up-to-date approach for performing a thyroidectomy with tiny scopes means that thyroid surgery is easier to undergo and leaves minimal scarring on the patient’s neck. This is one type of minimally invasive surgery performed at Fort Worth ENT to treat various ear, nose, and throat conditions.
Each year in the United States, several tens of thousands of people must undergo surgery for problems related to the thyroid gland. In fact, the prevalence of thyroid cancer is increasing, with the amount of thyroidectomies in the U.S. increasing over the last 10 years, as well. The thyroid gland can be accountable for a myriad of thyroid disorders and thyroid disease, but typically, specialists recommend thyroid surgery most often to treat thyroid nodules, over-activity of the thyroid gland, and thyroid enlargements known as goiters. A thyroid nodule is a very common abnormality of this gland, which will, along with any other suspected abnormality, warrant a series of tests or evaluations of the gland for cancer or other problems. This usually includes blood tests, an ultrasound, and possibly a needle biopsy to extract thyroid cells for further pathological evaluation. If the patient is diagnosed with a thyroid problem that requires surgical intervention, he or she may have the option to consider a fairly new and minimally invasive form of thyroid surgery to remove all or part of the thyroid gland.
Minimally invasive thyroid surgery may be an option for patients diagnosed with benign thyroid problems and even small thyroid cancers. Minimally invasive thyroid surgery is actually much like a traditional thyroidectomy in its surgical method. The principal differences in the minimally invasive approach include the size of the instruments used to remove all or part of the thyroid, as well as the size of the actual incision that must be made to perform the procedure. This results in a decrease in the discomfort and pain associated with this procedure and greatly increases the cosmetic outcome of a thyroidectomy.
History Of Minimally Invasive Thyroid Procedures
In the late 1990s and early 2000s, less invasive techniques for performing a thyroidectomy were established for the treatment of small thyroid nodules. This approach was developed to help increase cosmetic results, reduce postoperative discomfort, and hopefully decrease the length of patients’ hospital stays as well. Two minimally invasive approaches to thyroidectomy include the minimally invasive open thyroidectomy (MIT) and the most current and effective method, the minimally invasive video-assisted thyroidectomy (MIVAT).
Recent Advancements In Minimally Invasive Thyroid Surgery
Currently, specialists are still working to significantly improve and advance the already refined surgical methods for thyroid gland problems in order to employ the most minimally invasive, aesthetically pleasing, and health increasing techniques simultaneously. Other than the face, the neck is the most cosmetically delicate area of the body, and as a result, research companies and specialists have expended a large amount of resources in producing the most advanced and nominally invasive way to surgically treat this sensitive area.
To date, the most minimally invasive way of performing such operations is a surgery that is physically less difficult to be subjected to, easier to recover from, is just as effective and health increasing as traditional thyroid surgery in many cases, and causes only a tiny scar on the person’s neck. Using the minimally invasive video-assisted thyroidectomy (MIVAT) method, endocrine surgical specialists can today, as opposed to making a 4-5 inch incision and leaving a noticeable and lifelong scar, use a very small endoscope and other small instruments to perform the surgery through an incision no longer than one inch or less. These exciting advancements in performing thyroidectomies have a number of benefits, which cause these techniques to supersede conventional surgical methods for patients diagnosed with problems treatable though the minimally invasive approach.
Types of Thyroid Surgery
A total thyroidectomy is the complete removal of the thyroid gland for patients with thyroid cancer or large benign tumors. After the removal of the entire thyroid gland, a patient will be required to take hormone replacement medication for the rest of his/her life.
A thyroid lobectomy is the removal of either the left or right lobe of the thyroid for patients with a thyroid nodule or multiple nodules on just one lobe. After surgery to remove only one lobe, the other is usually able to compensate hormonally for the entire function of the thyroid gland and medication is not needed permanently.
Depending on the patients’ particular case and medical situation, it is possible that both a total thyroidectomy and a thyroid lobectomy can be performed with minimally invasive techniques. This depends on the particular thyroid abnormality being treated.
How Minimally Invasive Thyroid Surgery Is Done
The minimally invasive video-assisted thyroidectomy (MIVAT) approach is the most advanced form of thyroid surgery today. For MIVAT, a specialized endocrine surgeon will first make a small horizontal incision in the lower neck that is an inch or less in length. Through the small incision, the surgeon will insert a tiny endoscope (medical instrument that is ½ cm in diameter with a small camera attached to the end), which allows the surgical team to view the whole thyroid gland and surrounding tissue up on a video monitor, without having to physically open up and reveal it. The surgeon will then insert another very small instrument called the harmonic scalpel to resect parts of the thyroid tissue. The harmonic scalpel employs ultrasonic energy to very tenderly and accurately cut tissue, ligate blood vessels, and remarkably decrease operative time for thyroid surgery. The adaptability and flexibility of this new and extremely precise harmonic scalpel actually allows for the smaller incision. With much smaller and narrowed instruments than used in conventional thyroidectomies, the surgeon is able to push other structures like muscle tissue to the side rather than having to cut through them to reach the gland area and cause more trauma to the body. The surgeon will then extract sections of the gland or possibly the whole gland.
Before Undergoing Minimally Invasive Thyroid Surgery
The surgeon must first deem the patient’s particular thyroid abnormality treatable through the minimally invasive video-assisted thyroidectomy (MIVAT) method. The patient will undergo preoperative laboratory tests such as a CBC count, baseline serum electrolyte levels, a coagulation panel, and pregnancy testing, if relevant. The patient may also need to undergo a chest x-ray and an electrocardiography tests before undergoing MIVAT. After a thorough discussion with the surgeon, the patient, when consenting to MIVAT surgery, will likely also need to provide consent for conversion to open, conventional thyroidectomy if this is needed intraoperatively.
What To Expect During Minimally Invasive Thyroid Surgery
Typically, minimally invasive thyroid surgery takes between 30 and 90 minutes to perform, depending on the amount of the gland being removed. Most of the time, patients undergo general anesthesia for a thyroidectomy, but with the minimally invasive form of this procedure, some patients may only need local anesthetic, although this is rare. The surgeon will also use a monitoring system to make sure the laryngeal nerves, which are located near the thyroid gland, are not damaged during the procedure.
The procedure will be performed as described in the above section ‘How Minimally Invasive Thyroid Surgery Is Done’, and afterwards, the incision will either be closed with a minimal amount of sutures or, more preferably, a specifically designed surgical glue. If the special surgical glue can be used, no drains or wound dressing is required, which significantly minimizes the postoperative recovery process.
What To Expect After Minimally Invasive Thyroid Surgery And During Recovery
A minimally invasive thyroidectomy is usually an outpatient procedure, meaning the patient is able to return home a few hours after the surgery. After minimally invasive thyroid surgery, patients can typically return to normal activities the next day, excluding activities that require turning of the head. These activities may include things like driving, and can take a bit longer to perform without discomfort.
The patient will be given postoperative medications including analgesics, antemetics, and antibiotic prophylaxis. If given postoperative thyroid hormone supplementation, this medication should be continued long-term.
Following the patient’s release, he or she must return to the surgeon’s office for a follow up check 1-2 weeks after the operation and again 6 weeks later. During these visits, the wound healing will be evaluated, and the need for any further treatment plans will be considered. If the patient is having any problems with hoarseness or shortness of breath, the physician may need to evaluate vocal fold movement as well.
Possible Complications Of Minimally Invasive Thyroid Surgery
The possible complications of MIVAT are consistent with a conventional thyroidectomy and tend to occur at a corresponding rate. It has been shown in one study, however, that infections of the surgical site are notably less with the minimally invasive endoscopic method. Possible complications include:
- Wound infection
- Hematoma/bleeding
- Laryngeal nerve injury
Benefits and Outcomes Of Minimally Invasive Thyroid Surgery
Due to the use of endoscopic tools, much smaller incisions are required for minimally invasive thyroid surgery, which leads to smaller and less noticeable scars. The cosmetic outcome is much more pleasing than after a conventional thyroidectomy, which can leave a permanent scar up to 5 inches long. The use of endoscopes also allows for less tissue disruption in the structures surrounding the thyroid, which leads to a quicker and less painful recovery for the patient.
The recent and increasing success of the MIVAT technique among patients with more serious thyroid abnormalities is causing this mode of treatment to become more widespread and a possible option for larger cohorts of patients than what the traditional criteria dictates.
Overall, the level of satisfaction related to undergoing MIVAT, as opposed to conventional thyroidectomy, is extremely high among patients who meet the criteria for this advanced procedure and medical professionals who offer this treatment.
If you would like to learn more about this advanced procedure, schedule appointment with one of our physicians at Fort Worth ENT & Sinus by completing an online appointment request or phone 817-332-8848.
