New Transaxillary Approach to Thyroid Surgery

A new form of robotic endoscopic surgery uses a small incision under the arm to remove all or a portion of the thyroid or parathyroid glands without leaving a scar on the neck.

The new technique, called robotic transaxillary thyroid surgery, was developed at Yonsei University College of Medicine (Seoul, Republic of Korea) by associate professor of surgery Woong Chaung, M.D. The technique has benefits that go beyond aesthetics; unlike other forms of endoscopic thyroid surgery, it does not require insufflation of the neck to create space to perform the operation, which can cause complications if the gas is retained in the neck or chest after surgery, including significant discomfort and postoperative complications. The technique uses three-dimensional (3D), high-definition robotic equipment to make a two-inch incision below the armpit that allows doctors to maneuver a small camera and specially designed instruments between muscle fascias to access the thyroid. The diseased tissue is then removed endoscopically through the armpit access incision. Because the robotic camera provides 3D viewing with image magnification of up to 10 times normal size, there is a reduced likelihood of laryngeal nerve damage and less risk of trauma to the parathyroid glands. Patients who have undergone the procedure have reported less discomfort and faster recovery times after the new procedure.

"This is an exciting new treatment option for certain patients who need thyroid surgery but are concerned about having a visible and permanent neck scar,” said Emad Kandil, M.D., chief of the endocrine surgery section at Tulane University School of Medicine (New Orleans, LA, USA). "This technique safely removes the thyroid without leaving so much as a scratch on the neck.”

Thyroid surgery is frequently used to treat thyroid cancer and is sometimes the preferred approach to dealing with goiter, nodules, or an overactive thyroid. Other indications for surgery include cosmetic appearance or symptomatic obstruction, which can cause difficulties in swallowing or breathing. One of the complications of the surgical procedure is voice change, and patients are strongly advised to be operated on only by surgeons who protect the voice by using electronic nerve monitoring. Most thyroidectomies are now performed by minimally invasive surgery.

Related Links:
Yonsei University College of Medicine
Tulane University School of Medicine