Minus the Scar
Enhancing Patients’ Satisfaction with Aesthetic
The thyroid gland plays a key role in the maintenance of vital hormonal
balance in the body. A swelling in thyroid gland, accompanied by a
normal or abnormal hormonal profi le, when detected, is therefore a
source of concern, and may have to be examined to rule out malignancy
and other problems like thyroid nodules and hyperthyroidism. In cases
where surgery is advised, existing methods indicate an open surgery
for a partial or complete excision of the gland - resulting in signifi cant
blood loss, trauma, permanent and distinct scarring.
Traditional thyroidectomies leave a visible scar in the middle of the
neck. Nowadays, a variety of endoscopic surgical approaches have been
in practice by surgeons. Some of these approaches are discussed here.
Endoscopic Thyroidectomy (Axillary Breast approach): Various
standard endoscopic approach for thyroid surgery are now practiced
by making incision site in armpit and peri areola region, which are
generally covered areas and hence scar is not visible directly. Ports are
placed in various combinations in armpit and anterior chest wall and peri
areolar breast region to reach the neck using conventional Laparoscopic
instruments. A sub platysmal working space is created and thyroid is
then dissected using endoscopic instruments as done for conventional
surgery with added cosmetic benefi ts.
Posterior auricular approach: This technique uses a potentially hidden
space behind the ears and occipital hair line and is also a gasless technique.
The patient lies in a supine position with the head slightly rotated away from
the side of pathology. The incision is then made along the post-auricular
crease extending into the occipital hairline. The SCM is dissected along its
anterior border. The greater auricular nerve and external jugular vein are
identifi ed and retracted interiorly. The avascular space between the SCM
and the strap muscles is developed and the working space is maintained
by an external retractor. The dissection of the thyroid gland begins using
endoscopic instruments in the superior pole and then proceeds inferiorly.
This leaves a scar behind the hairline which is not visible easily.
Trans-oral Thyroidectomy: It is feasible to excise the thyroid gland
through an incision in the fl oor of the mouth under gas insuffl ation.
This approach seems to be technically feasible but challenging. The
working space is very limited and potential infection through a relatively
contaminated incision is a major concern. This procedure requires two
working and one camera port.
Robotic Thyroidectomy: Since the fi rst report of Robotic Transaxillary
Thyroidectomy in 2009, Robotic Thyroidectomy has been widely
performed worldwide. Theoretically, it overcomes many of the technical
challenges associated with transaxillary thyroidectomy because the
robot can provide a three-dimensional magnifi ed view, seven degree of
freedom and 90° articulation and can fi lter any hand tremors.