The neck is a cosmetically sensitive area and any scar can look prominent in the neck. Conventional open thyroid surgery leaves an undesirable scar in front of the neck. Over the years there have been attempts to reduce the neck scar. Minimally Invasive Thyroid Surgery (MITS) technique reduced the scar size on the neck (2-3cm) which made it little more acceptable. The more technically advanced Laparoscopic (endoscopic) Thyroid Surgery avoids wound in the neck, thus making the surgery scarless. The wounds are small and hidden in areas that are not visible. All types of thyroid surgeries including those for thyroid cancer can be performed by laparoscopic thyroid surgery. Even Laparoscopic (endoscopic) Parathyroid Surgery is performed in the same way as thyroid and has the same advantages. The predominant advantages laparoscopic thyroid surgery would be:
The thyroid gland is an important endocrine gland located in front of the neck below the Adam’s apple. The gland two lobes and is shaped like a butterfly. The gland wraps the front of windpipe or trachea. The bridging portion is called isthmus, which crosses over the front of the windpipe.
Parathyroid glands are located on the back of thyroid gland. These are four of these glands and these are intimately related to thyroid gland. They control the calcium levels in the body.
Thyroid nodules can occur in any part of the gland and the occurrence increases with age. Most of these nodules are benign and do not need any form of intervention. However, when nodules are noted an ultrasound scan and needle biopsy (FNAC) is indicated to identify a suspicious nodule.
Parathyroid glands can enlarge (tumor) and cause severe disturbance (increase) in calcium levels. All parathyroid nodules have to be surgically removed whether they are cancerous or not.
All thyroid nodules that are found to contain cancer or highly suspicious of containing a cancer should be removed surgically. Most thyroid cancers are curable with treatment. If the nodule appears benign on FNA or is too small to biopsy (<1cm), it may be closely followed with ultrasound examination every 6 to 12 months.
This table is a broad idea about the possible treatments for the conditions.
Type of thyroid nodule
|Adenomas– Follicular and Hurthle cell neoplasms||There is a 20% risk of cancer in these cases. Surgical removal of affected lobe of thyroid gland (hemi-thyroidectomy) is needed.|
|Cancer– Papillary, follicular & medulary cancer||Total thyroidectomy (surgical removal of entire thyroid gland) with or without removal of lymph nodes is needed.|
|Multi nodular goiter (MNG)- contains multiple nodules or cysts||Does not usually require any treatment unless there is symptom due to pressure and for cosmetic reason when surgery is needed.|
|Thyroid Cyst – contain blood or fluid||Does not usually require any treatment unless there is symptom due to pressure, pain and for cosmetic reason when surgery is needed.|
|Hyperfunctioning Nodule – nodule produces excess thyroid hormone causing server symptoms||Needs medical treatment for controlling excess hormone and then surgery to remove the gland.|
|Parathyroid tumor (from a gland next to thyroid, but felt in the same area of neck)- causes calium imbalance in the body.||The affected parathyroid gland needs surgical removal.|
Papillary thyroid cancer. Papillary thyroid cancer is the most common type, making up about 70% to 80% of all thyroid cancers. Papillary thyroid cancer can occur at any age. Papillary cancer tends to grow slowly and often spreads to lymph nodes in the neck. However, unlike many other cancers, papillary cancer has a generally excellent outlook even if there is spread to the lymph nodes. A central compartment (nodes close to thyroid) dissection is performed in most of the cases.
Follicular thyroid cancer. Follicular thyroid cancer, which makes up about 10% to 15% of all thyroid cancers in the United States, tends to occur in somewhat older patients than does papillary cancer. As with papillary cancer, follicular cancer first can spread to lymph nodes in the neck. Follicular cancer is also more likely than papillary cancer to grow into blood vessels and from there to spread to distant areas, particularly the lungs and bones.
Medullary thyroid cancer. Medullary thyroid cancer, which accounts for 5% to 10% of all thyroid cancers, is more likely to run in families and be associated with other endocrine problems. In family members of an affected person, a test for a genetic mutation in the RET proto-oncogene can lead to an early diagnosis of medullary thyroid cancer and, subsequently, curative surgery to remove it.
Anaplastic thyroid cancer. Anaplastic thyroid cancer is the most advanced and aggressive thyroid cancer and is the least likely to respond to treatment. Fortunately, anaplastic thyroid cancer is rare and found in less than 2% of patients with thyroid cancer.
Conventional open surgery. The conventional open surgery of the thyroid gland uses a standard, open-surgery approach requiring an incision that is 8-15 cm in length. The incision is longer for total thyroidectomy and for cancers than hemithyroidectomies (removal of half of the gland). Open surgery results in noticeable lifelong scar in the lower portion of the patient’s neck. This can be cosmetically bad.
Minimally Invasive Thyroid Surgery (MITS) involves using small (3-4cm) incision in the neck to surgically remove the gland. This is made possible by advanced equipments and techniques. However, a small scar remains in the neck after the wound heals.
Laparoscopic (Endoscopic) Thyroid Surgery. In this procedure the surgeons accesses the gland via 3 small incisions near the armpit and near nipples. The wounds are located in the crease of armpit (covered area) and near nipple, and are mostly invisible once they heal. There are no wounds in the neck. Thyroid cancers also are treated laparoscopic total thyroidectomy with lymph node dissection.
Laparoscopic Parathyroid Surgery are performed in the same way as thyroid and have the same advantages.