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MINIMALLY INVASIVE SURGERY THYROID SURGERY

OVERVIEW

Surgeons are now able to use advanced techniques to operate on the thyroid gland. This surgery is done through a very small incision that can be made some distance from the gland, like under the armpit or in the chest area. The surgeon can be guided in the operation using an endoscope. They will discuss which options are available depending on the patient's needs, the surgeon’s experience, and the equipment available at the hospital. Not all people are eligible for a minimally invasive approach.

ABOUT THE PROCEDURE

Minimally invasive video-assisted thyroidectomy (MIVAT) is a refinement of endoscopic surgery in which both endoscopes and video scopes are used. Endoscopically guided surgery involves using a small magnifying camera inserted in the neck or under the arm. The incision is only 1.5 to 3 cm long. Carbon dioxide gas may be pumped into the neck area to help make it easier to see and work on the gland. A second small incision is then made. A thin tube with a scalpel-like edge is inserted through that second incision. This tube is the surgical tool that is used to remove the thyroid.

Robot-assisted endoscopic surgery is the most recent development in thyroid surgery. The use of robots provides surgeons with a three-dimensional, magnified view of the area being operated. It also allows for very precise movements to be made. Large movements of the surgeon’s hands are translated into tiny movements of the surgical instruments by the robotic system.

Whichever surgical method is used, the blood supply to the gland is "tied off" (stopped). The surgeon then separates the trachea (wind pipe) from the thyroid and then removes all or part of the gland.

During the operation, the surgeon will take great care to identify and avoid damaging the nerves to the voice box that are found just behind the thyroid gland. Injuring these nerves can severely affect the ability to speak, swallow, or breathe. Use of a NIM™ nerve integrity monitoring system from Medtronic may help the surgeon identify these nerves, monitor them, and confirm they have not been damaged during surgery.1,2

The surgeon will also take care to identify and preserve the four small parathyroid glands that lie next to the thyroid gland. These four very small glands produce a hormone called parathormone, which controls calcium levels in the blood.

LEARN MORE ABOUT WHAT TO EXPECT

BENEFITS AND RISKS 

The principal benefit of thyroid surgery is that it should relieve some or all of the symptoms that the patient may have been experiencing. The main benefits of a minimally invasive approach are that there is less pain after the operation, recovery is faster, and the resulting scar is much smaller than with the traditional approach. Ask the doctor for a detailed explanation of the benefits and risks of the surgery, as well as their experience performing this kind of procedure. As with all surgery, there are possible complications that may occur during or following.3

Thyroid hormone-replacement

Depending on how much of the thyroid gland is removed, it is likely the patient will need some form of thyroid hormone replacement therapy after surgery.

Hypoparathyroidism

The parathyroid glands, which are located very close to the thyroid gland, control the body's calcium levels. If the parathyroid glands are damaged during surgery, this can cause temporary or (rarely) permanent shutdown. This results in a lowered calcium level, called hypocalcemia. Temporary hypoparathyroidism affects about 7% of people. Symptoms of hypoparathyroidism, which usually appear in the first few days after surgery and last for about a week, may include:

  • Numbness and tingling feeling around the lips, hands, and the bottom of the feet
  • Crawly feeling in the skin
  • Muscle cramps and spasms
  • Bad headaches
  • Anxiety
  • Depression

These symptoms are treated with calcium tablets.

Laryngeal nerve damage

The nerves that control the voice (laryngeal nerves) pass very close to the thyroid. There is a risk that they may be damaged during surgery. This happens in about 1 out of every 250 thyroid surgeries.4 The damage is likely to be temporary and can cause changes to the voice such as:

  • Difficulty projecting the voice
  • Hoarse voice
  • Voice fatigue
  • Decreased vocal range

Usually, permanent changes are rare, and the voice will return to normal within a few weeks.

General risks of surgery

As with all surgery, there is a risk of bleeding after the operation, as well as some risk from anaesthesia and possible infection. Ask the doctor about potential complications from the procedure.

1

ANZ Thyroid IONM Consensus Statement. ANZ J Surg 84 (2014) 603–605.

2

Flukes S et al. Intraoperative Nerve Monitoring in Otolaryngology: A Survey of Clinical Practice Patterns International Journal of Otolaryngology and Head & Neck Surgery, 2013, 2, 21-26.

3

Perigli G. Clinical benefits of minimally invasive techniques in thyroid surgery. World J Surg. 2008-Jan;32(1):45-50.

4

Thomusch O, Sekulla C, Walls G. Intraoperative neuromonitoring of surgery for benign goiter. Am J Surg. 2002 Jun;183(6):673-8.