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Dr. Manmohan M. Kamat

Dr. Manmohan M. Kamat
Sr. Consultant
Minimal Invasive Surgery
Nanavati Super Speciality
Hospital, Mumbai



TRANSORAL TECHNIQUE

Benign Thyroid Anomaly, Treated Kindly

THE CASE

A 55 year old female with left thyroid solitary nodule was found to be Euthyroid on investigation. Further FNAC procedure revealed the benign nature of nodule. She had a history of controlled hypertension.

THE PROCEDURE

The patient was planned for a scarless surgery of thyroid (Hemithyroidectomy). The oral cavity of the patient was washed with saline and betadine. Endotracheal intubation was done through the nasal route. The approach was through the inferior vestibule of the oral cavity where the ports were placed and included one midline 10 mm camera port and two lateral 5 mm working ports. The operative field was insufflated with carbon dioxide which provided us with easier access. The sub-platyssmal plane was entered and dissected. The deep fascia was opened in the midline and strap muscles retracted. The isthmus of the thyroid gland was identified and divided.

The superior and inferior pedicles on the left side were identified and divided by ultra scission. Recurrent laryngeal nerve was identified and preserved. Haemostasis was secured. The left lobe was brought out through the oral cavity using an endobag. The deep fascia was closed using absorbable sutures and the vestibular port sites were closed in layers using absorbable sutures.

THE RESULT

Patient had minimal post operative lower lip oedema which subsided in 24 hours. Patient had no pain and was discharged the day after surgery without any pain or scar. The follow-up revealed that patient had no discomfort / disfigurement.
This is a Natural Orifices Transoral Endoscopic Surgery (NOTES), an excellent technique for dealing with benign thyroid disorder.