Thyroidectomy and Parathyroidectomy
Thyroidectomy :-
Minimally Access Thyroid Surgery-
Thyroid cancer is an uncommon disease. However, many common thyroid disorders simulate thyroid cancer, and surgical excision of portions of the thyroid gland is frequently necessary for diagnosis. This means that many people undergo surgery for a benign problem and acquire a disfiguring visible scar as a result. Techniques now exist to minimize the length of incisions for most thyroid surgeries.
Videoassisted Thyroidectomy–
This technique markedly shortens incision length, reduces post-operative pain, and speeds return to normal function. The pioneering work of surgeons in Italy demonstrated the safety and feasibility of the video-assisted thyroidectomy. This is conceptually a fairly minor modification – the basic sequence of steps in the procedure are nearly identical to a conventional open thyroidectomy – however, the incision is generally confined to 2-3 cm in length, recovery is reduced, and less pain is experienced postoperatively. This technique simply involves making a much smaller incision, using retractors to create a working space around the gland, and supervising the thyroid procedure using endoscopes.
Totally endoscopic thyroidectomy–
A second, more sophisticated variation of Minimally Access thyroid may be an option for some patients. Using special instrumentation and techniques, part or all of the thyroid gland can be removed through small puncture sites in the armpit, avoiding any incision on the neck whatsoever. In this technique, the skin overlying the collarbone is lifted from the underlying muscle and laparoscopic techniques are used to create a working space. The muscles of the neck are identified, and the thyroid procedure is performed exactly as it would be in an open procedure. The surgeon operates using laparoscopic instruments and supervises the case through endoscope cameras under high magnification.
Video-assisted technique-
- A mini-incision (typically less than 2 cm)
- An endoscope and specialized instruments provide excellent lighting and magnification for removal of the parathyroid gland
- An intraoperative blood test confirms removal of the overactive parathyroid gland (PTH level falls immediately after removal of abnormal gland)
- Band-Aid dressing
Minimally Acess approach-
- No scar
- Avoids any neck incision
- Armpit incisions are virtually invisible
- Easier recovery
- Operative times comparable to open technique
- Band-Aid or skin glue dressings
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Parathyroidectomy–
Minimally Access Parathyroidectomy-
Hyperparathyroidism typically involves a single parathyroid gland which overproduces parathyroid hormone (PTH), causing elevated calcium and a variety of systemic side effects. Most people have four small parathyroid glands in the region of the thyroid gland. The conventional procedure involves a lower neck incision with sequential identification of each gland until the enlarged gland is encountered. Once found, the abnormal gland is removed.