Minus the Scar

Enhancing Patients’ Satisfaction with Aesthetic
Thyroid Surgery

The thyroid gland plays a key role in the maintenance of vital hormonal balance in the body. A swelling in thyroid gland, accompanied by a normal or abnormal hormonal profi le, when detected, is therefore a source of concern, and may have to be examined to rule out malignancy and other problems like thyroid nodules and hyperthyroidism. In cases where surgery is advised, existing methods indicate an open surgery for a partial or complete excision of the gland - resulting in signifi cant blood loss, trauma, permanent and distinct scarring.

Traditional thyroidectomies leave a visible scar in the middle of the neck. Nowadays, a variety of endoscopic surgical approaches have been in practice by surgeons. Some of these approaches are discussed here.

Endoscopic Thyroidectomy (Axillary Breast approach): Various standard endoscopic approach for thyroid surgery are now practiced by making incision site in armpit and peri areola region, which are generally covered areas and hence scar is not visible directly. Ports are placed in various combinations in armpit and anterior chest wall and peri areolar breast region to reach the neck using conventional Laparoscopic instruments. A sub platysmal working space is created and thyroid is then dissected using endoscopic instruments as done for conventional surgery with added cosmetic benefi ts.

Posterior auricular approach: This technique uses a potentially hidden space behind the ears and occipital hair line and is also a gasless technique. The patient lies in a supine position with the head slightly rotated away from the side of pathology. The incision is then made along the post-auricular crease extending into the occipital hairline. The SCM is dissected along its anterior border. The greater auricular nerve and external jugular vein are identifi ed and retracted interiorly. The avascular space between the SCM and the strap muscles is developed and the working space is maintained by an external retractor. The dissection of the thyroid gland begins using endoscopic instruments in the superior pole and then proceeds inferiorly. This leaves a scar behind the hairline which is not visible easily.

Trans-oral Thyroidectomy: It is feasible to excise the thyroid gland through an incision in the fl oor of the mouth under gas insuffl ation. This approach seems to be technically feasible but challenging. The working space is very limited and potential infection through a relatively contaminated incision is a major concern. This procedure requires two working and one camera port.

Robotic Thyroidectomy: Since the fi rst report of Robotic Transaxillary Thyroidectomy in 2009, Robotic Thyroidectomy has been widely performed worldwide. Theoretically, it overcomes many of the technical challenges associated with transaxillary thyroidectomy because the robot can provide a three-dimensional magnifi ed view, seven degree of freedom and 90° articulation and can fi lter any hand tremors.

Dr. Vivek Aggarwal

Dr. Vivek Aggarwal
Endocrine Surgery
BLK Super Speciality
Hospital, New Delhi