Scarless Endoscopic Thyroidectomy

Surgery for the thyroid gland is usually done throgh a transverse incision in the lower part of the front of the neck. Most people especially unmarried women and men hesitate to undergo the surgery because of this reason. Though this scar will hardly be recognizable in a small group of patient, in the others it will remain prominent. The problem is that it is impossible to predict the behavior of the scar.

 Picture of classical scar

Surgeons have been incessantly trying out methods to decrease the size of the scar or totally avoid the scar. A new technique of Endoscopic Thyroidectomy is now available. In this the thyroid is approached thro the region of the axilla and the side of the breast by Keyhole method (called the Axillo Breast approach). Using the conventional laparoscope and instruments the thyroid is dissected and removed. Since suturing is not practical  in this type of surgery , ultrasonic cutting instruments are used for cutting and coagulation of blood vessels at the same time. The final scars will be small and at areas covered by the dress.

Diagram showing the approach

  

The first Endoscopic Thyroidectomy in Kerala was done at the MIMS hospital Calicut, in the general surgery department, in Nov 2011. A right Hemithyroidectomy (Removal of the Right half of the thyroid) was done on a 39 yr old lady. The second operation of this type was done on a young unmarried girl recently. Removal of the whole thyroid gland also can be done by the same technique. The time take for the operation is slightly higher than the conventional procedure.

While performing a Thyroidectomy, the surgeon needs to identify and preserve the nerves to the voice box (larynx) and also the minute parathyroid glands which are situated just behind the thyroid. Damage to the nerve can cause changes in the voice and damage to the parathyroid glands can cause the blood calcium levels to become low. In the Endoscopic method the magnification provided by the endoscope facilitates this more objectively. 

Endoscopic view of  nerve and parathyroid glands
 

Since the scars are small, the pain is less and the patients are happy to go home earlier. The term minimally invasive may be a misnomer for this operation since the areas that are dissected are more than in the conventional thyroidectomy. The advantage mainly lies in the situation and the size of the scars. 

Choosing the cases suitable for endoscopic thyroidectomy is important. Patients with very large goiters, Thyrotoxicosis, thyroiditis, thyroid cancers and recurrent thyroid swellings are not the ideal candidates for this surgery. This approach is a boon for those who need thyroid surgery but are worried about a scar in the neck.

Dr. Rojan Kuruvilla

Sr. Consultant Surgeon, Department General Surgery, MIMS Calicut.

Dr. Rojan did his MBBS and MS from Medical College, Calicut.  After two years as junior surgeon at the AKG Memorial Hospital, Kannur, he joined the department of surgery at the Christian College, Vellore, as Senior lecturer in surgery and continued in that capacity for five years. During this period he obtained the Diplomat of the National Board in Surgery. Following this, he went on to U.K and worked as Registrar in Surgery at the North Thames rotation for three years and completed FRCS from Edinburgh during that period. On his return, he went on to head the Department of Surgery at Pushpagiri Hospital in Thiruvalla before joining MIMS. His special interests include Thyroid, Parathyroid, Endovenous surgery for varicose veins and Laparoscopic Hernia Surgery in which he gained training and expertise while he was abroad. He has one of the largerst series of focused Parathyroidectomy in the state.The first Scarless Endoscopic Thyroidectomy Surgery in Kerala was done by him in Nov 2011. 

About MIMS Hospital:

Malabar Institute of Medical Sciences Ltd (MIMS) is an NABH Accredited hospitals in  Kerala renowned for its excellent medical expertise and diagnostic services. It is located at the heart of Calicut and administered by highly qualified medical professionals. The hospital has an emergency and trauma care unit supported by a blood bank. It is one of the best hospitals in India renowned for quality service and patient safety.
Visit http://www.mimsindia.com