Minimally invasive approaches to thyroid surgery are commonly requested by our patients. However, deciding on the right surgical approach for any given patient and disease process takes a thoughtful, honest, and experienced surgeon with appropriate technical training to guide you through the benefits and shortcomings of each surgical approach.
The term “minimally invasive” is a bit of a misleading description as the surgical approach actually can create a much larger wound space that needs to heal when compared to a standard open incision. Why this is the case will be illustrated below. A more accurate description of the surgery is “remote scar” or even “scarless” surgery – the technique is specifically designed to place a scar in a location that is not visible on the neck. The typical locations for scars, depending on the technique, is behind the ear, under the arm, along the nipple or breast, on the chest, or in the mouth. Only the transoral technique will leave a truly scarless surgery; the other techniques will have a surgical scar that is placed outside of the regular field of view and possibly hidden underneath hair-bearing areas.
Due to the remote location of the incisions, the surgical technique will need to create a working space to allow for instruments such as forceps, camera, and dissecting devices to seal and divide blood vessels to be inserted into the surgical field. These instruments are used to manipulate the thyroid gland during dissection from blood vessels, nerves, parathyroid glands, etc., to allow for safe removal of the thyroid.
The technique was developed primarily in Asia to offset the unacceptable cosmesis associated with keloid formation on the front of the neck. Keloid scars occur with significantly greater frequency in patients with higher degrees of skin pigmentation (e.g., African descent, Asian, Hispanic, etc.) than in Caucasian patients, with estimates ranging from 7-15 times greater frequency. Extracervical placement of surgical incisions allows for these scars to be hidden from view, leaving the patient with a “scarless” neck.
The surgical procedure does not offer improved surgical exposure or a better or safer operation when compared to open surgery. The primary goal of remote access surgery is to maximize the cosmetic outcome from a neck surgery.
Now, for patients who develop significant keloid scars, one of these approaches may provide significantly improved cosmetic outcomes in comparison to standard open techniques. Of the different surgical approaches, the transoral technique provides the only surgical approach which truly eliminates the presence of a scar. Additionally, of all of the remote access surgical approaches, it is the most direct operative approach to the thyroid gland, creating the smallest wound space.
The transoral thyroidectomy technique has been successfully applied at select surgical centers throughout the United States, such as UCSF, Mount Sinai, Baylor, and Johns Hopkins. It is a new technique and very limited in its exposure. The Endocrine Surgeons at North Carolina Surgery are the first to have successfully performed transoral thyroid surgery in the state of North Carolina.
If you are interested in considering transoral thyroid surgery, we would encourage you to come in to discuss the details of the operative approach, and whether you would be a candidate to have this surgical approach performed.