Minimally Invasive Thyroid Surgery

In the hands of the experienced surgeon, tiny scopes and other instruments mean that thyroid surgery has minimal cosmetic impact.

Aria's exceptional endocrine surgeons can now perform these operations using robotics, for even greater precision and less invasiveness.  Learn more about robotic assisted surgery.
While the thyroid gland can be responsible for a range of thyroid disorders, specialists use thyroid surgery primarily to treat patients who have a nodule (or nodules), an enlargement, or overactivity of this gland.  Thyroid nodules in particular are a common condition, often detected by the patient or the patient's doctor by feeling the area of the thyroid, or discovered incidentally in a radiologic exam, or detected as a result of thyroid symptoms that the patient may be experiencing. 

Patients with a thyroid abnormality, or suspected thyroid abnormality, will undergo various tests or evaluations of the thyroid gland, normally including blood tests to check thyroid function and an ultrasound study.  A needle biopsy to remove cells in the thyroid, for evaluation in the pathology lab, can also add important information to the diagnosis.

While drug treatment is called for in patients who have overactivity of the gland, biopsies can identify nodules that may not need surgical intervention.  Surgical removal is the primary form of treatment for any mass in or on the thyroid gland for which a diagnosis cannot be made or masses that have the diagnosis, or suspected diagnosis, of a tumor, nodule, or benign enlargement.  The thyroid may be subject to full or partial removal for these and other disorders of the thyroid.  Many tens of thousands of patients undergo such thyroidectomies each year in the U.S.

Minimally Invasive Surgery Recently Available

Surgery for the thyroid gland is now undergoing a significant advance.  The most up-to-date approach for performing such operations is a procedure that is easier to undergo and recover from than traditional thyroid gland surgery, as effective as conventional surgery, and –– most importantly –– leaves only a tiny scar on the patient's neck. 

The neck is a cosmetically sensitive area.  (The face is the only area of the body of greater cosmetic concern than the neck.)  Consequently, specialists and technology companies have invested resources into developing the least invasive approach possible for surgically treating this area.

Aria is one of the few centers in the Delaware Valley offering minimally invasive thyroid surgery.
Traditional, conventional surgery of the thyroid gland uses a standard, open-surgery approach requiring an incision that is four to five inches in length.  The result is a noticeable and sometimes prominent, life-long scar on the lower portion of the patient's neck.  Today, specialized endocrine surgeons with the latest in training can offer an approach to thyroid surgery that uses the kind of minimally invasive, endoscopic methods that have benefited so many other areas of surgical treatment in medicine.

These qualified specialists can perform this surgery through an incision that is a mere inch or less (approximately) in length.  Through this small cut, they insert a tiny endoscope that is only a half-centimeter in diameter.  This instrument permits them to see the thyroid gland and surrounding tissue without having to physically expose it.  With the scope, they can view the gland on a video monitor.  They can then use another miniaturized instrument called the harmonic scalpel to resect portions of thyroid tissue.  This scalpel uses ultrasonic energy to gently and precisely cut tissue and to seal off (ligate) blood vessels, significantly reducing operative time in thyroid surgery.  As a surgical tool, this type of scalpel offers a level of versatility that makes the newer, smaller incisions possible.  With slender instruments, the surgeon pushes aside other structures, such as musculature, rather than cut through them, to get to the gland area.  The surgeon removes and retrieves sections of the gland in the surgical treatment and for biopsy specimens.

Surgical specialists in Europe have been using this procedure - variously referred to as laparoscopic thyroid surgery or endothyroid surgery or minimal access thyroid surgery or video-assisted thyroidectomy - since the early 1990s, with good success.  To date, though, only a few centers in the U.S. have committed to the training and equipment required for performing this superior procedure.  Aria has provided this minimally invasive thyroid surgery option at an expanding pace and has already successful treated hundreds of patients with it. 

What To Expect In Thyroid Surgery

Conventionally, patients received general anesthesia for thyroid surgery.  But in the Aria program, some patients may only need local anesthesia and moderate sedation for thyroidectomy.  (The option of avoiding general anesthesia is rare capability to offer and one that requires special experience and skill.)  Our team also uses a monitoring system for the laryngeal nerves, to safeguard these structures, which are situated close to the thyroid and which control the vocal cords. 

The Role of Traditional, Open Surgery

At top-level, thyroid-surgery practices, such as that at Aria, conventional open surgery continues to have an important function.  While many patients today are candidates for minimally invasive endoscopic surgery, a significant percentage has a gland too large to remove through a small opening.  In these cases, the surgeon must use tradition methods to remove the thyroid.

This approach is a safe, and long-used and established, operation.  It is an important part of an endocrine-surgery group's options, especially for patients with large goiters, inflammatory conditions, and hyperthyroidism.

Thyroid surgery normally takes between 30 and 90 minutes, depending on whether the surgeon removes the entire gland.  The traditional approach requires sutures or clipping of the wound and considerable packing for the bandaging the site.  But after minimally invasive thyroid surgery, incisions for Aria patients are closed with a newer method that uses specially developed surgical glue, so that no dressing or drains are required at all.  Our staff considers this a safer approach, and other advanced centers have adopted the technique as well.

Minimally invasive surgery is typically an outpatient procedure, with most patients going home within in a few hours of the operation.  Traditional surgery almost always means at least a one-night stay in the hospital.

Any patients undergoing thyroid surgery will experience a few days of hoarseness and soreness in the throat, but patients who undergo the minimally invasive procedure will have less discomfort around the external wound.   This helps to speed recovery and hasten return to normal daily activities.  Patients can usually go home in one to two hours after minimally invasive thyroid surgery.  They can resume most normal activities the next day, although return to driving or other activities that require turning the head comfortably may take slightly longer.

Full or Partial Thyroidectomy 

The thyroid is a butterfly-shaped gland at the front of the neck.  An undiagnosed thyroid nodule is the most common condition for which patients undergo thyroid surgery.  And, most patients with thyroid growths, with any type of pathology of the thyroid, (excepting those with large nodules) are candidates for the minimally invasive approach.  But, conducting a thorough and conclusive pathological evaluation is often difficult with thyroid lesions, unless the growth or the gland itself is completely removed.  At that point, the pathologist can examine the tissue in the lab and make a more definitive determination of whether the condition is malignant or benign. 

Partly as a result, roughly half of thyroid surgery patients receive a total removal of the gland (thyroidectomy), while the other half of this population will only undergo removal of the left or right side of the gland (lobectomy).  Patients with a known cancer of the thyroid will receive a complete thyroidectomy.  For patients receiving a partial removal, a portion of the gland must undergo pathology analysis in the lab to assure that is it safe to leave the remaining portion of the gland behind.  In partial thyroidectomy, the team sends the removed portion of the gland for immediate evaluation by a pathologist while the operation is going on.  Based on this analysis the surgeon may remove the remaining portion of the gland or leave it in place.  The pathologist further evaluates the removed sample after the surgery is complete.   Based on this analysis, a second surgery is necessary in a few cases.

High Satisfaction and Preference for Minimally Invasive Surgery

With traditional surgery, a scar of as much as four inches (and sometimes more) was typically very apparent on a permanent basis on the necks of patients who underwent thyroid surgery.  But, with minimally invasive thyroid surgery, any mark left by the procedure is nearly invisible after approximately six months.  Patients who receive this procedure also have less soreness around the site and faster recovery (faster wound healing) than patients who receive traditional surgery.  Thus, minimally invasive surgery helps to get patients back to their regular routine more quickly.

Use of Surgery Balanced Among Men and Women

Thyroid conditions are common and can affect both men and women of all ages.  Yet many of these conditions are far more prevalent in women, and, in fact, women are more likely to have nodules on the thyroid gland.  However, these nodules are more likely to require treatment when found in men.  Thus, while thyroid conditions in general are associated more often with women, use of surgery for thyroid conditions is more evenly balanced between men and women.  

The level of satisfaction about the experience of undergoing minimally invasive thyroid surgery, and about the outcomes from it, has been very high among patients and medical professionals (including referring endocrinologists and family physicians).  Many more patients could be benefiting from this capability if awareness of its availability was higher among patients and the medical community.  Aria was the among the first centers in the region to offer minimally invasive thyroid surgery.

Making the care determinations described above and offering the right, best, and most advanced treatment for thyroid disorders, requires a specialty group with significant experience and training, and a dedicated focus on thyroid care.  Aria's thyroid service is provided by a team with exactly this type of commitment.

For more information or a consultation on minimally invasive thyroid surgery.