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Getting Small: Thyroid Surgery Gets Easier

A new surgical technique for removing diseased thyroids causes less scarring and leads to faster recovery times, according to a recent study. David Terris, MD, who directs the head and neck surgery department at the Medical College of Georgia, said that the main benefit is largely cosmetic.

With the aid of a tiny video camera and other high tech equipment, surgeons can now remove the thyroid, a peach-size gland that sits at the base of the neck, with a relatively small incision.

"This wouldn't make a big difference to me," said Dr. Terris, "But it does to my 21-year old daughter."

The procedure, which was outlined in Laryngoscope, improves upon an operation that was first developed in the late 19^th century. Thyroids help control growth and metabolism but they are commonly removed if they show suspicious growths that suggest cancer or other problems.

Traditionally, surgeons have removed or dissected the thyroid by making a three to four inch cut along the neck. This still remains the best option for those with an enlarged thyroid.

But Terris said that many surgical candidates could have their thyroids removed with an incision about one to two inches long, essentially half the size surgeons have previously needed to make.

In the study, Terris and his colleagues reported their experience with this new procedure. Of the 44 middle-aged patients who had evidence of diseased thyroids, about 65 percent were eligible for the newer procedure. The average incision for those who underwent the conventional surgery, known as a thyroidectomy, was 9.1 centimeters compared to 4.9 centimeters with the minimally-invasive thyroidectomy. Both approaches were equally safe, although one patient who had the smaller incision developed a skin reaction, which cleared up with treatment.

In addition to a smaller scar, the minimally-invasive technique causes less trauma to the muscles around the neck, allowing the incision to be closed with medical-grade glue, rather than stitches. While this procedure does take longer to perform, Terris said that patients can use a local anesthetic and be sent home the same day. "It's a marked improvement," he said.

Most suspected thyroid growths turn out to be harmless, raising concerns about unnecessary surgery. While various tests can help determine if the gland is diseased, they are expensive and difficult to perform. Even a biopsy, which is considered the best method for determining thyroid disease, can be inconclusive about 15 percent of the time. "Sometimes we don't know until we operate," said Dr. Terris.

Terris said that he performs five to six of these procedures a week, and that they are beginning to use even smaller incisions on some patients. If a thyroid does turn out to be cancerous, Terris said that he follows the same small incision to remove the rest of the diseased tissue. Thyroid surgery should be avoided if at all possible, but the less-invasive approach makes a difficult situation more tolerable.

"At least it's a little less hard on the patient," said Dr. Terris.