Statistical analyses were conducted using the Students t test and one-way ANOVA through the SPSS 23.0 software. Comparison of total endoscopic thyroidectomy with conventional open thyroidectomy for treatment of papillary thyroid cancer: a systematic review and meta-analysis. The majority of people will likely be candidates for this procedure. Patients will receive general anesthesia. However, the da Vinci system is blamed for a prolonged surgery duration and a significantly higher economic cost. It is no longer sufficient to remove a thyroid, preserve the laryngeal nerves, and preserve the parathyroid glands (Figure 42-4). 2021;19:23. There are two nerves called the recurrent laryngeal nerves that run just behind the thyroid. The alleviation of the discomfort in the anterior neck area and sternocleidomastoid, and the cosmetic effect of gasless endoscopic trans-axillary thyroid surgery were acceptable. The CAT scan will also allow the surgeon to see if the trachea is being moved to one side or the other and if it is being narrowed by the thyroid. In the last decade, we have performed this approach on more than 500 patients and found that patients who undergo this surgery have better cosmetic results compared with the . Substernal Goiter Surgery. Springer Nature. If the seroma is large, the surgeon may drain it with a small needle. Lobe TE, Wright SK, Irish MS. The MacFee incision (B) respects the relaxed skin tension lines in the neck and is therefore cosmetically superior, but it can be awkward to work through. Symptoms of hypocalcemia include numbness and tingling in your hands, soles of your feet and around your lips. B, C The recurrent laryngeal nerve (RLN) was identified and then traced. Endoscopic and robotic thyroidectomy for cancer. The size of the incision is dictated by surgeon preference and need for adequate exposure to remove the tumor. However, despite careful technique, it is not uncommon to observe skin edges at the end of a procedure (particularly minimally invasive surgery) that are ischemic and traumatized. Only gold members can continue reading. In the past decade, advancements in A c c e p t e d . 2011;25:161723. If the patient was taking thyroid hormone before the operation, they should continue taking the same dose unless it was changed by the surgeon. https://emedicine.medscape.com/article/2051665-overview. Temporarily lowered calcium levels occur in approximately 15-40% of patients, and is treatable with calcium and vitamin D supplementation post-operatively. Because much of the earlier thyroid surgery was done for malignancy, descriptions emerged regarding the appropriate way to accomplish a thyroidectomy combined with a neck dissection. Feeling that something is stuck in the throat. These symptoms appear between 24 and 48 hours after surgery. The total mean operative time was 141.6 34.4 min (range 95240 min, from anesthetic intubation to leaving the operating room and entering the postanesthetic care unit (PACU)). Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. A number of technological advances such as advanced energy devices for hemostasis, 1 high-resolution endoscopes for improved visualization, 2 and laryngeal nerve monitoring 3 have increased the focus on cosmetic outcomes and the pursuit of smaller, well-camouflaged incisions. Fifty-one patients (42 PTC patients and 9 thyroid adenoma patients) were included in this study. Patients who spend the night in the hospital are typically discharged by 10AM the next morning. Novel uses of surgical robotics in head and neck surgery. Great efforts are made during surgery to identify and preserve this nerve on both side of the thyroid gland. Temporary numbness of the anterior chest is very common after this operation, and can last for several months. Meanwhile, the postoperative stiffness and paraesthesia of the SCM can also be ameliorated due to the shorter surgical time, and improved surgical techniques. If all 4 glands are injured or removed during the operation, the blood calcium levels can become lower than normal called hypocalcemia. Thyroidectomy for substernal usually includes goiters with minimal extension in the thoracic cavity and those that are present in the mediastinum (the area surrounding the chest cavity ). We have been using this approach since 1999. The surgical drain was removed 2 days after surgery in all cases. Incisions as small as 1 inch (2.5 cm) can be performed for patients with favorable neck anatomy and small tumors. Patients in two groups underwent thyroidectomy through a supraclavicular lateral collar incision (approximately 5 cm). 2012;42:83541. The primary advantage of this surgical procedure is avoidance of an incision on the neck. The exclusion criteria were as follows: (1) patients with benign nodules with diameters > 6 cm, (2) patients who needed a total thyroidectomy, and (3) patients for whom endoscopic surgery was not suitable due to past medical history of cervical and chest wall surgeries or other reasons. Surg Oncol Clin N Am. wnya@Q7-$Omag[>JI[Kf;-TpOZ0v{ }b/n:WwWi4(^{=]~(O l4!|lgp$uWx)>lvK@#\K!i' y~F-yv~`=0%->s:K,z3/=K[po>@nrLo j, MIVAT combines the small incision with use of endoscopes to help provide illumination and visualization of the tumor. The stiffness and paraesthesia of the SCM resulting from the division of the SCM are also relieved over time. In the hands of our Columbia Thyroid Center surgeons, the chance of having a temporary hoarseness is 3% and the chance of having a permanent hoarseness is less than 1%. Lee et al. Patient concern about cosmetic appearance has led surgeons to explore performing surgery through smaller incisions to extract tumors. If the patient was not taking thyroid hormone prior to the operation, the surgeon may prescribe these tablets following surgery. ZYZ modified the design of the study. The neck appearance score (also known as the patient satisfaction score, PSSs) was applied to investigate the cosmetic effects. 4 Technologic This nonobese gentleman who has a 26-inch neck circumference and a large goiter would not be a candidate for any minimally invasive approach. A concept that has gained traction in recent years is the customization of both the incision and the surgery to the patient and the disease characteristics, rather than a one size fits all approach. No evidence of recurrence was found during the follow-up period. By contrast, a television commentator with an 11-inch neck (Figure 42-3, A) and a 2-cm follicular neoplasm (Figure 42-3, B) is an ideal candidate for an endoscopic thyroidectomy. Bilateral axillary approach for total thyroidectomy ensures better identification of recurrent laryngeal nerve (RLN) and PTG on both sides. Gasless endoscopic thyroidectomy using trans-axillary approach; surgical outcome of 581 patients. A special retractor is placed to create a space for the surgeon to remove the thyroid gland. OMIT is an open thyroidectomy performed through a short 'collar' incision and does not necessitate special equipment although two assistants are desirable. The sensory change and paralysis results from this technique and patients satisfaction with the cosmesis were also studied. Classically 8-12 cm (3-5 inch) incisions were performed. A The retractors were used to maintain the working space during the operation. During the procedure: Goiters are noncancerous enlargement of the thyroid gland. Rarely, a patient may have temporary changes in the voice such as fluctuations in volume and clarity (hoarseness). This is the result of the blood calcium level dropping below normal (hypocalcemia) and is usually temporary. This technique can be performed on incisions as small as 2.0 cm (0.8 inches), and generally has excellent healing and cosmetic result. If a patient has symptoms caused by low blood calcium, the surgeon may prescribe extra calcium and a vitamin D supplement. In the absence of contraindications, substernal goiter should be treated with early surgery rather than having it run the risk of acute airway distress, especially in younger patients. It has been pointed out by Kang et al. Thyroid cancer is an increasingly prevalent malignancy worldwide [].Surgery is the most commonly used technique in treating thyroid diseases. The procedure is not indicated for aggressive thyroid cancers, for very large tumors, or tumors with significant inflammation such as severe Hashimotos thyroiditis, Graves disease, or in patients who are significantly obese or have abnormalities of shoulder function. low collar incision The middle thyroid vein was then ligated. The trans-axillary approach (TA) can hardly locate the contralateral thyroid lobe, causing the limitation of TA in bilateral thyroidectomy. 2). After the seventh day, reduce the calcium to one Tums Ultra 1000 tablet three times a day until your follow-up appointment. The typical recommendations for pre-operative testing include: In addition, patients may require additional tests in certain situations to help plan the operation. E, F Step three, the strap muscles were dissected laterally and the retractor was placed beneath the straps muscle to expose the thyroid lobe. Traditionally, parathyroidectomy involved a collar incision, bilateral exploration of the neck, identification of all four glands, and removal of the diseased gland or glands. A thyroid lobectomy may be done for a variety of diseases including indeterminate lesions on fine needle biopsy (See Thyroid Nodules Diagnosis and Treatment ), a toxic nodule (See Hyperthyroidism ), substernal goiter, and an enlarging thyroid nodule, among others. None of the patients developed hypoparathyroidism, esophageal injury, or surgical site infection after the surgery. Parathyroidectomy Thyroid storm, also called thyrotoxic crisis, is a life-threatening medical emergency caused by very high levels of circulating thyroid hormone. Conventional open thyroidectomy (COT) is the most commonly used approach for thyroidectomy. These nerve control the vocal cords. 2016;23:694700. Minimally Invasive Thyroid Surgery The typical incision made for thyroid surgery is known as a "collar incision" in which a large incision (around 5 to 6 inches) is made stretching from one side of the neck to the other just above the collar bone. To date, conventional open thyroidectomy through a collar incision is the standard approach to thyroidectomy (4). Columbia University Irving Medical Center, Department of Surgery, New York, NY. Patients now expect a more measured approach to their care, which sometimes includes quite small incisions (Figure 42-5). Anyone you share the following link with will be able to read this content: Sorry, a shareable link is not currently available for this article. 55 0 obj <>/Filter/FlateDecode/ID[<92107CDBA3A8D84ABDC22C73C8947E84>]/Index[32 48]/Info 31 0 R/Length 106/Prev 453493/Root 33 0 R/Size 80/Type/XRef/W[1 2 1]>>stream Several reports with large case cohorts were regarding robotically assisted thyroidectomy [8,9,10]. Medscape. It provides a good alternative beyond 2.5cm . When this happens, you can trim the edges or let the glue fall off on its own. Introduction The standard approach to thyroidectomy is a collar incision via the anterior neck, and the neck scar has always been a source of worry for patients. Acceptable wound cosmetology has . While the majority of patients accept a thyroidectomy scar, a certain percentage of patients are not satisfied with a visible scar on the neck. This procedure ensures patients cosmetic needs by making incisions under the axilla, which allows for the removal of nodules, even large nodules [7]. Retractor was placed beneath the strap muscles to finish creating the working space (Fig. If symptoms of hypocalcemia develop, take an extra two Tums Ultra 1000 tablets and if the symptoms do not go away after 30 minutes, call your doctor. You might notice bruising around your incision or upper chest and slight swelling above the scar when you are upright. Figure 42-4 Examples of the so-called necklace neck incision associated with a classical thyroidectomy through an open approach (A and B). Thyroid Nodules Diagnosis and Treatment , Follicular Thyroid Cancer/ Hurthle Cell Carcinoma. Conventional thyroidectomy In a conventional thyroidectomy, a 3- to 4-inch incision will be made through the skin in the low collar area of your neck (the lower front portion of your neck, above the collarbones and breast bone). Most of the time, the surgery can be done this way. All existing creases can be mapped out in order to configure an incisional line that is parallel to a regional crease. Later on, in 1880, Jules Boeckel of Strasbourg introduced the collar incision to thyroid surgery, and this approach was popularized, later on, by Theodor Kocher. 4 Also emerging are techniques for remote access thyroid and However, depending on the presence of any visible skin crease, a higher incision at the cricoid level along the visible skin crease is sometimes preferred to enhance the cosmetic outcome (Fig. We make every effort to eliminate the use of 4 4 gauze sponges during the operation, as the material is abrasive and behaves like sandpaper when it is placed into and retrieved from small incisions. XYL, HOY, WBX, and ZYZ performed the study, collected the data, and contributed to the design of the study. Opening of the chest in the surgical management of substernal goiter is rarely required. The primary endpoint was the cosmesis of the collar scar six weeks after surgery assessed using the patient and observer scar assessment scale (POSAS). Popular incisions included the Lahey incision (Figure 42-1. One must be cautious that normal creases may (especially in the more lateral portion of the neck) become asymmetrical and even V like in nature, rather than the more symmetrical rounded creases of the lower central neck. Minimally invasive thyroid surgery refers to certain types of surgery in which the thyroid is removed through very small incisions using special techniques. B A 4-cm length incision was made in the natural wrinkle of axilla and an accessory 5-mm incision was made for another operative instrument, Three standard steps method for working space make. The procedure for thyroidectomy and CND was similar to that of other endoscopic and open approaches. Privacy 2021;99:26775. In this study, we reported our initial experiences with 51 patients who underwent gasless endoscopic trans-axillary thyroid surgery performed by a single experienced surgeon. In each patient, the indication for surgery was a small nodule of unclear malignant potential. Endoscopic hemithyroidectomy with prophylactic ipsilateral central neck dissection via an unilateral axillo-breast approach without gas insufflation for unilateral micropapillary thyroid carcinoma: preliminary report. Figure 42-6 The optimal position in which to mark the anticipated thyroid incision is with the patient seated upright in the holding area. D Thyroid isthmus was dissected. The primary surgeon performs surgery by manipulating the instruments in the robotic arms from a console adjacent to the patient, and a bedside surgical assistant can change instruments on the robotic arms, and perform additional tasks to support the primary surgeon. Piccoli et al. Patients should not be worried about hurting their voice by talking. have been classified as minimally invasive. Ann Surg Oncol. They have a higher death rate due to postoperative complications. As per the largest study done, the rate of sternotomy is less than 5%, the complication rates are acceptable, and the mortality is less than 1%. This work was supported by the National Natural Science Foundation of China (grant No. With the transformation of thyroid and parathyroid surgery since the late 1990s, there are now a variety of methods for accessing the thyroid and central neck. This study kept the confidentiality of patient data and strictly complied with the Declaration of Helsinki and its later amendments or comparable ethical standards. We also recommend a multivitamin for most patients. Patients diagnosed with thyroid cancer and thyroid nodules with diameters > 4 cm who underwent trans-axillary thyroid surgery from July 2020 to March 2021 in Xiangya Hospital were retrospectively enrolled. The time of LT with or without CND was 40.9 15.1 min (range 3090 min). Most patients will feel like they have a sore throat for the first few days after the operation, especially when swallowing. Risks of the thyroid surgery include the risks common to all surgeries including risks associated with administration of general anesthesia, bleeding, and infection. Aside from fine needle or core needle aspiration of the thyroid gland, the minimal operation for management of the thyroid is hemithyroidectomy, or thyroid lobectomy. The size of the incision is dictated by surgeon preference and need for adequate exposure to remove the tumor. By using this website, you agree to our During the limited follow-up periods, no recurrence has been found. While the conventional collar incision is widely used, endoscopic thyroidectomy is gradually becoming accepted for thyroid nodule patients with cosmetic needs [2,3,4].Under the premise of oncological effectiveness, endoscopic thyroidectomy can provide a . The average blood loss was 21.0 26.8 ml (10200 ml). The vast majority of patients do not require narcotic pain medications. In addition, the scar may become pink and hard. It is noteworthy that there is another obvious disadvantage of this technique. Our data indicated that sensory changes around the anterior chest are relieved over time in most cases. Thyroid cancer often spreads to lymph nodes in the neck. The operation generally lasts from 2-3 hours. Figure 42-7 When a large thyroid lobe is delivered through small incisions, it is not uncommon to observe evidence of an ischemic or traumatized skin edge (A). 2016;26:3317. 2021;35(7):3540-3546. https://doi.org/10.1007/s00464-020-07814-y. Most patients (97%) will not notice any change in their voice after the operation. For standard-length incisions, a good alternate choice, if a normal symmetrical crease is not available, is a line parallel to a normal skin crease. Endoscopic versus conventional thyroid surgery: a comparison of quality of life, cosmetic outcomes and overall patient satisfaction with treatment. &P3J&lwT,Y+noVac?GEbd1ygA( All rights reserved. Most people will not be able to notice the incision once the redness fades away. J Laparoendosc Adv Surg Tech A. Your incision is covered with a protective strip of clear glue called collodion. Popular incisions included the Lahey incision (Figure 42-1, A), the MacFee incision (Figure 42-1, B), and eventually a hockey stick type of incision (Figure 42-1, C).8 This last approach developed with recognition of the dangers of a trifurcated incision in which the tips of the trifurcation were prone to ischemia and devitalization, sometimes putting the great vessels of the neck at risk. WHERE WILL THE INCISION BE? As the scar heals, it will appear to be part of the crease and thus camouflage it. Although researchers made some efforts to achieve it by sectioning the sternohyoid muscle, the long operation duration, pain in the neck, and swallowing discomfort should also be taken into consideration. Temporary or sometimes permanent hypoparathyroidism (low blood calcium levels). Gasless, endoscopic trans-axillary thyroid surgery is a feasible procedure with acceptable safety and better cosmetic results in strictly selected patients. The location of the tumor was right, n= 30; left, n= 21. Patients should call their surgeon's office to make a follow up appointment 3 weeks after surgery. Kim SK, Park I, Hur N, Lee JH, Choe JH, Kim JH, et al. 82073262) and the Hunan Province Natural Science Foundation (grant number 2019JJ40475). UC Irvine was the first institution on the West Coast of the United States to perform this operation. Clinical findings and postoperative complications of patients who had undergone trans-axillary thyroid surgery due to thyroid cancer and thyroid nodules were retrospectively studied. A number of technological advances such as advanced energy devices for hemostasis,1 high-resolution endoscopes for improved visualization,2 and laryngeal nerve monitoring3 have increased the focus on cosmetic outcomes and the pursuit of smaller, well-camouflaged incisions.4 Also emerging are techniques for remote access thyroid and parathyroid surgery.5,6 Conventional surgery remains necessary in many circumstances, such as for large substernal goiters or advanced malignancy, and will remain in the endocrine surgeons armamentarium. In the past, piecemeal or berry picking operations have been advocated, but currently, removal of all lymph nodes in all levels or compartments containing metastatic nodes is performed. Jsls. No evidence of recurrence was found during the follow-up period. The rate of permanently low calcium levels after a total thyroidectomy is anywhere from 1-5%. Kendall Jenner and her new love Bad Bunny were both seen arriving at the Mark Hotel in New York City on Monday ahead of their anticipated arrival at the Met Gala later in the evening. Department of General Surgery, Xiangya Hospital, Central South University, No. A P value < 0.05 was considered as statistically significant. In this operation, an incision is made in the axilla (armpit) and dissection is carried superiorly across the collar bone into the neck. The nodes may be referred to as level 6 lymph nodes based on the AJCC staging criteria. This procedure may also be appropriate for small, non-aggressive thyroid carcinomas less than 1cm. hb`````Jg`a`6Tcg@ ~+s\``fy$ S@5@YN@ZA:V^`` HWy6rC+1oxD7`v`Xvz&fq=@&2` &{^j@ 8S Fortunately, in the hands of Columbia Thyroid Center surgeons, the risk of bleeding is less than 1%. 14,17,18 Indications for OMIT are defined as thyroid volume >30ml but <70-80ml and a dominant nodule . It is important to minimize the amount of trauma to the skin edge, either from retraction or from inadvertent instrument trauma (for example, electrocautery and ultrasonic energy burns or gauze abrasion). A, B Step one, dissection of the route to the anterior neck area. The final pathology is ready approximately1 week after the operation. 79 0 obj <>stream World J Surg Onc 20, 9 (2022). Because the thyroid gland is situated directly in front of the trachea, or windpipe, airway obstruction may occur if blood collects in the area after surgery. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. Based on this procedure, Kang et al. However, thyroidectomy is still difficult because the thyroid gland is rich in blood supply and is adjacent to parathyroid glands and important nerves. Rong Cong and Xinying Li contributed equally to this work. This will disappear over the next 3 to 6 months. However, patients will be asked to do no heavy lifting, swimming, or soaking in a bathtub for 1 week after the operation. The paratracheal lymph nodes are divided into pretracheal, prelaryngeal, and right and left lateral paratracheal lymph nodes. (A and B, Redrawn from Lore JM, Medina JE, editors: Atlas of head and neck surgery, Philadelphia, 2005, Elsevier-Saunders.). During the 1850s, operations on the thyroid gland were undertaken via longitudinal, oblique, or vertical neck incisions. In conclusion, these results revealed that gasless, endoscopic trans-axillary thyroidectomy is a feasible surgery type with an acceptable safety profile and cosmetic outcomes in strictly selected patients. Many companies make these suits, and they're washable and reusable. In addition to using very small incisions, our surgeons "hide" the incision in a natural skin crease which acts like camouflage. Please see the Expert Consult website for more discussion of this topic, including Figures 42-2, 42-3, 42-4, and 42-5. The addition of robotics can improve surgical dexterity in a difficult-to-reach anatomic region [6]. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. n7z0#L1gV>>Z1>~G|s1OG3(dzmJ ')6bF1]/Bpp ~ x>$;oz5/^xJqE_CqK.mu,;L.&?-Y-NM>FyZ-;,pCpfC !DC),!S?Iy,`SDt further described gasless endoscopic thyroidectomy through the axillary region, which can effectively avoid the influences of carbon dioxide [8]. Ryan WR. How helpful the three-dimensional endoscopy or robotic endoscopy to the completion of bilateral (total) thyroidectomy via trans-axillary approach is worth further exploration. Your incision will be located on the front of your neck. The VRSs in a short time (1 week) were significantly higher in the first 25 cases than in the last 25 cases (the patient whose operation was converted to open surgery was excluded). Temporary hoarseness usually gets better within a few weeks, but can take up to 6 months to resolve. Jiang WJ, Yan PJ, Zhao CL, Si MB, Tian W, Zhang YJ, et al. 202011960). Only two patients developed temporary vocal cord paralysis and no patients developed other severe complications. In the hands of Columbia Thyroid Center surgeons, the risk of having a temporarily low blood calcium level is about 5% and the risk of having a permanently low blood calcium level is less than 1%. The recurrent laryngeal nerve provides nerve input to the vocal cords, and is also intimately involved with the thyroid gland. Patients may also be given a prescription for thyroid hormone medication (Levothyroxine or Synthroid). Lee DY, Oh DJ, Kang KR, Kim MS, Oh KH, Baek SK, et al. Surg Endosc. 2011;25:135863. that the dissected flap width in trans-axillary approach is significantly wider than conventional thyroidectomy, causing greater trauma, and potentially more severe pain [20]. 2 ). Most people take at least 15-30 days to recover. Thyroid. Mitchem JB, Gillanders WE. Classically, standard thyroid lobectomy or thyroidectomy has been performed through an incision low in the neck called the low collar incision. No internal jugular vein injury was reported [19]. In the other case, the hemorrhage of IJV has been controlled by using Harmlock clips (Fig. Columbia Thyroid Center surgeons perform minimally invasive thyroid surgery in over 95% of patients, typically using an incision measuring just an inch to an inch and a half in length. Indications: Proven neoplasm (FNAC) Suspected neoplasm Age: Extreme Sex: Male It is nearly always preferable to identify and utilize a preexisting skin crease (if present), as this will result in the most optimally camouflaged scar. In this way, the incision can be planned with the patients input and awareness. reported the endoscopic trans-axillary technique. Most patients may need to take thyroid hormone pills (thyroid hormone replacement) for the rest of their lives when the whole thyroid gland is removed. What percentage of the human body is water? Most thyroid nodules are small, and performing a full collar incision is not necessary to provide needed surgical exposure to safely remove the thyroid lobe. 2005;15:64752. Thyroid nodules and cancer management guidelines: comparisons and controversies. At the Columbia Thyroid Center, 95% of our patients are able to go home after a 4 hour observation period in the recovery room. Medication to normalize abnormal thyroid hormone levels may help decrease the size of goiters. Surgery is typically recommended for goiters that are causing symptoms. The hockey-stick incision (C) avoids trifurcations and provides plentiful exposure for a comprehensive neck dissection. Acceptable wound cosmetology has . Manage cookies/Do not sell my data we use in the preference centre. As the sternal head of the SCM was elevated by the retractor during the procedure, the decreased VRSs may be partly due to the shorter surgical time and improved surgical techniques. American Thyroid Association Statement on Remote-Access Thyroid Surgery. Collar incision was made about 2 1/2cm above the inner ends of the clavicle, through the platysmal muscle. In cases of indeterminate lesions, some surgeons refer to a thyroid lobectomy as a diagnostic lobectomy because the main purpose of the operation is to make a diagnosis cancer or benign thyroid disease. . After the seventh day, reduce the calcium to one Tums Ultra 1000 tablet three times a day until your follow-up appointment. The risk of a substernal goiter is higher in people who: 1996-2023 MedicineNet, Inc. An Internet Brands company. Transaxillary robotic thyroid lobectomy and transaxillary robotic thyroidectomy were developed in Korea, and over the last several years has been utilized by a small but growing number of surgeons. Once at home, patients and their friends/family should watch for signs such as difficulty breathing, a high squeaky voice, swelling in the neck that continues to get bigger, and a feeling that something bad is happening. Our study suggested that the lateral supraclavicular incision is a safe and practical approach for thyroidectomy. XYL and HOY analyzed the data. Prior to the operation, patients will need certain pre-operative testing to make sure that they are healthy enough and properly prepared for an operation. All authors have no conflicts of interest or financial ties to disclose. statement and The follow-up times were 3 to 10 months. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. In the hands of an experienced thyroid surgeon, thyroid surgery is a safe procedure with few complications. B, With wide elevation of subplatysmal flaps, all levels of the neck are accessible. Duncan et al. Despite the additional trauma resulting from the flap formation, the application of the trans-axillary approach is of some value in suitable circumstances. A 5-6 cm transverse collar skin incision was made into the midline of the anterior neck 2 cm above the sternal notch.
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