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Robotic face-lift technique eliminates neck scar from thyroidectomy
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A robotic face-lift approach to thyroidectomy precludes noticeable neck scars for patients and facilitates the procedure for surgeons, according to two new studies.
Although minimally invasive techniques for thyroidectomy decrease the size of incisions, a sophisticated technique developed in Korea involving bilateral axillary surgery and incisions behind each ear eliminated a neck scar altogether, according to David J. Terris, MD, surgical director at GeorgiaHealth Thyroid Center. Terris and colleagues sought to make this approach easier by employing robotic technology (da Vinci Surgical System, Intuitive Surgical Inc.) and using a face-lift incision to remove the thyroid.
“We were intrigued by this application of a postauricular face-lift type of access portal with which we were already familiar in order to get to the thyroid gland,” Terris told Endocrine Today.
Supporting studies
Results from an initial cadaver study conducted by Terris et al indicated that accessing the thyroid gland, identifying the important structures and removing it through a face-lift incision were feasible. Further, data showed that the mean area of dissection for the robotic face-lift thyroidectomy was 39.2 cm2 — a 38.3% decrease from the 63.5 cm2 required for the robotic axillary thyroidectomy.
In a second study, the researchers employed the robotic face-lift technique for 18 procedures in 13 women and one man (mean age, 33.7 years; mean BMI, 26.9). They reported that all except one were outpatient procedures performed without a drain. None required conversion to open surgery, and permanent nerve injuries and hypoparathyroidism did not occur in any patients. Findings also suggested that the procedure was easy to perform in slightly obese patients.
“We’ve done almost 40 procedures now where we have very successfully and in a virtually complication-free fashion been able to remove half of the thyroid gland using this approach,” Terris said.
Precautions, implications
Although beneficial, Terris said the procedure is only appropriate for certain patients, such as those for whom scarring is clearly an issue, and certain physicians, such as high-volume surgeons.
Terris also said the face-lift approach has other important implications. “By and large, people performing thyroid surgery are middle-aged men,” he said. “It is harder for them to relate to the needs and desires of the patient population that we deal with, which is largely younger women. We need to get past that and embrace patient-centered care, while acknowledging that the principal concern is a safe and thorough removal of the thyroid gland. We can now offer the same type of safety and thoroughness in a way that may appeal more to selected patients.” – by Melissa Foster
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Disclosure: Dr. Terris directs thyroid courses sponsored by Johnson & Johnson.
The face-lift thyroidectomy is only appropriate for small-sized, unilateral thyroid tumors. A complete removal is not possible without doing two incisions (one on each side). I would add a few more criteria for this procedure other than the two mentioned. The lesion must be small-sized; must only be unilateral; noncancerous; and the patient should have no history of neck or face surgery.
– Amy Chen, MD, MPH, FACS
Associate Professor, Otolaryngology-Head and Neck Surgery, Emory University
Disclosure: Dr. Chen reports no relevant financial disclosures.
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