Only two patients developed temporary vocal cord paralysis and no patients developed other severe complications. The addition of robotics can improve surgical dexterity in a difficult-to-reach anatomic region [6]. Retractor was placed beneath the strap muscles to finish creating the working space (Fig. Objective: To verify the effectiveness and cosmetic results of thyroidectomy through a lateral supraclavicular incision. For example, a gentleman with a 26-inch neck (Figure 42-2, A) and a large goiter (Figure 42-2, B) is not a good candidate for any type of minimally invasive approach. The surgeon has excellent magnified visualization, can manipulate the camera to customize the view of the field, and works with surgical instruments that are more maneuverable than the human wrist and hand. Application of lateral supraclavicular incision in unilateral thyroid 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. Bhargav PR, Kumbhar US, Satyam G, Gayathri KB. PDF Care of the Surgical Incision - American Thyroid Association Thyroidectomy Guide: Causes, Symptoms and Treatment Options - Drugs.com Perhaps the most important element in optimizing access while maintaining good cosmesis is choosing the proper location for an incision. 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. The surgeon makes a cut (incision) in the lower part of the neck just above the collar bone to determine if the mass can be removed without opening the chest. https://doi.org/10.1186/s12957-021-02484-z, DOI: https://doi.org/10.1186/s12957-021-02484-z. We also recommend a multivitamin for most patients. Despite the additional trauma resulting from the flap formation, the application of the trans-axillary approach is of some value in suitable circumstances. 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. Figure 42-4 Examples of the so-called necklace neck incision associated with a classical thyroidectomy through an open approach (A and B). Seromas happen rarely and usually disappear within a few weeks. 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)). Jules Boeckel of Strasbourg introduced the collar incision to thyroid. Supraclavicular lateral collar incision versus conventional approach 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. All rights reserved. Department of General Surgery, Xiangya Hospital, Central South University, No. Collar incision was made about 2 1/2cm above the inner ends of the clavicle, through the platysmal muscle. Approximately 70% of patients who have half of a normal thyroid gland left in place will not require thyroid hormone replacement pills. A tube may be left in place to drain fluid and blood. Expert thyroid care for adults and children. 82073262) and the Hunan Province Natural Science Foundation (grant number 2019JJ40475). Duncan et al. Article a skin incision was made using scalpel, A, An extended low cervical collar incision is used when a lateral neck dissection is indicated. A 5- to 7-cm arc incision was made along the dermatoglyphic direction, 1-2 cm above the sternal notch. Wound infections happen in about 1 out of 2000 operations (far less than 1%) and because of this low risk, the routine use of antibiotics is not needed. Substernal goiter can be removed through a relatively straightforward collar incision in the lower neck. Second, we divided the area between the sternal and clavicular head of the SCM, up to the annular cartilage and down to the clavicle. If the mass is deep inside the chest, the surgeon makes an incision along the middle of the chest bone. Feeling that something is stuck in the throat. This consists of removal of one lobe of the thyroid gland, and the isthmus of the gland. Muenscher A, Dalchow C, Kutta H, Knecht R. The endoscopic approach to the neck: a review of the literature, and overview of the various techniques. Standard incisions that are placed too low, spanning this indented suprasternal notch region, may appear asymmetrical and tend to be hypertrophic in their midsegment as opposed to incisions higher, in a more uniform, cylindrical region of the neck. Google Scholar. With this type of anesthesia, you are completely asleep during the operation, and you will have a breathing tube placed temporarily to protect your airway and lungs. h. 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. Some patients experience a "crawling" sensation in the skin, muscle cramps or headaches. Most patients (97%) will not notice any change in their voice after the operation. PubMed Central If any of these symptoms happen, the patient should call 911 first and then their surgeon. It is prudent to resect a sliver of skin edge on either or both sides of the incision (B), which leads to a more predictable healing result and minimizes the risk of hypertrophic scarring. The muscles around the thyroid gland are retracted to expose the thyroid gland. Kang SW, Lee SC, Lee SH, Lee KY, Jeong JJ, Lee YS, et al. 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. Verbal response scores (VRSs) for sensory changes around the anterior chest and paralysis of the SCM (1-week, 1- and 3- month visits) were as follows: 0 = Never, 1 = Sometimes, 2 = Most of the time, 3 = All the time [14]. Thyroid Surgery Recovery, Side Effects, and Complications - Verywell Health Patients should discuss with their doctors when and if they should restart these medications. B In this case, the hemorrhage of IJV has been controlled by using Harmlock. Huang Z, Qin H, Liao J, Meng L, Qin Y, Li B, et al. WBX and ZYZ drafted the Result, Discussion, and Conclusion sections. If the patient was not taking thyroid hormone prior to the operation, the surgeon may prescribe these tablets following surgery. Last, the strap muscles were dissected laterally, the omohyoid muscle and internal jugular vein (IJV) were also exposed. Closure of skin incision after thyroidectomy through a supraclavicular Surg Endosc. A popular alternative to cones is a post-op surgical/recovery suit. Temporary nerve damage occurs in 6-8% of cases. A special retractor is placed to create a space for the surgeon to remove the thyroid gland. Remote access is focused by many surgeons in the decade to be a feasible technique in thyroidectomy avoiding the neck scar caused by conventional surgery, which includes endoscopic or robotic approaches [16, 17]. Our data indicated that sensory changes around the anterior chest are relieved over time in most cases. The surgical procedure was similar to the methods described by other surgeon groups [11, 12]. Kang JB, Kim EY, Park YL, Park CH, Yun JS. 2016;23:40238. The opposite lobe is not removed, and in general the remaining thyroid gland will produce enough thyroid hormone for the body. Patient concern about cosmetic appearance has led surgeons to explore performing surgery through smaller incisions to extract tumors. 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. 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. In this study, 51 patients accepted gasless, endoscopic trans-axillary thyroid surgery with only one patient whose operation was converted to open surgery. Patients may also be given a prescription for thyroid hormone medication (Levothyroxine or Synthroid). Rarely, nerve injury to the arm can occur, resulting in impaired arm and/or hand function. 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 ). However, it also leads to greater trauma [22]. Traditionally, parathyroidectomy involved a collar incision, bilateral exploration of the neck, identification of all four glands, and removal of the diseased gland or glands. Most patients will feel like they have a sore throat for the first few days after the operation, especially when swallowing. Ann Surg Treat Res. Ryan WR. For images of a functional neck dissection, see following images. Gasless, endoscopic trans-axillary thyroid surgery is a feasible procedure with acceptable safety and better cosmetic results in strictly selected patients. Rarely, a patient may have temporary changes in the voice such as fluctuations in volume and clarity (hoarseness). During the post operative visit, a blood test called TSH level may be checked to measure the levels of thyroid hormone in order to determine if the dose is correct. 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. In general, patients may resume taking their normal medications the day after the operation. Meanwhile, prospective clinical studies are needed to investigate and validate surgical and oncological outcomes.
collar incision for thyroidectomy