Sunrise Group of Hospitals completed 100 endoscopic thyroidectomies in 2014, in Cochin and Dubai center (International Modern Hospital) together has performed these procedures by the team led by Dr. R Padmakumar. Sunrise Group of Hospitals is one of the very few centers in the world doing endoscopic (key hole) thyroidectomy. These procedures were done via small cuts in the armpit (axilla) without any cut in the neck. Parathyroid surgery by similar method was also performed at these centers with excellent outcome.
Generally, the surgical solution available in most of the places across the globe is open thyroidectomy which involves a large transverse cut across the lower part of the neck. This definitely leads to an unsighty scar which is not acceptable, especially for women.
The endoscopic thyroidectomy – the keyhole or minimally invasive technique is a very good alternative to other methods. It gives excellent cosmetic outcome especially when done by an axillary approach. It gives equal or even a better surgical outcome as far as the actual thyroid nodule management is considered. There are other less preferred endoscopic approaches like sternal and breast approach.
The procedure of endoscopic thyroidectomy by axillary approach involves the following steps. A 10 mm trocar placement in the axilla towards neck for the telescope; which initially helps in creating the plane and visualization of structures with magnification, precision and clarity.
Then two 5 mm trocars are introduced in to the dissected space (sub platysmal) which are used as working ports. We use a less heat generating energy source the harmonic scalpel instead of cautery for tissue dissection.
Once space is created in the neck, the sternomastoids and strap muscles gets exposed. We can open the investing layer in midline and reach the thyroid gland. The gland is mobilized by blunt dissection and vital structures identified. The recurrent laryngeal nerve (important for respiration) the superior laryngeal nerve (for voice) and parathyroids (for calcium metabolism) with their blood supply will be preserved. The blood vessels are divided and gland detached from trachea. A specimen bag is used to place the thyroid and removed by dilating 10 mm trocar. For a total thyoidectomy one will have to put additional trocars on the opposite side and do the same steps on that side as well.
The investing layer is sutured back, drain is placed and the trocar sites closed. Patient is asked to be in the hospital for 24 hours only and can resume all kinds of activities in a few days.
These patients will have less wound related problem compared to open surgery group. The cosmetic outcome is such excellent that the small wounds in axilla heals with minimal scarring and gets covered with small inner-wears.
The earlier belief was that the endoscopic, no neck scar option for thyroid swellings are applicable to lesions of less than 4 cm size. But we have observed that swellings of size of even 12 – 15 cm can be tackled very successfully through this method. The only pre-requisite will be a surgeon with good experience, in both laparoscopic surgeries and thyroid surgeries. The complications of this surgery are very similar to that of open surgery proving that it is a much desirable option. Any kind of pathologies like benign or cancerous nodules, thyoiditis can be safely tackled by endoscopic thyroidectomy. Completion thyroidectomy is much more easier with this technique as one do not dissect the other side while performing the opposite side. Lymph node clearance when indicated can also be comfortably performed by this route.