Minimally Invasive Thyroid Surgery

The thyroid gland is shaped like a butterfly and sits just below the voice box and in front of the trachea (wind-pipe). It resides just under a thin muscle layer in the midline central neck just above the sternal notch and moves with swallowing as it is attached to the trachea. The thyroid gland is a central organ in the body that secretes thyroid hormone and as such regulates our body’s metabolism, energy level and various other functions.

The critical structures that entail the most attention when surgeons operate in this area are the parathyroid glands and recurrent laryngeal nerves. There are four parathyroid glands that sit on the posterior surface of the thyroid gland, two usually on each side, that maintain our body’s calcium balance. There are also two recurrent laryngeal nerves, one on each side, that maintain our ability to produce voice by controlling each vocal cord. If one vocal cord is injured temporary or permanent hoarseness may ensue, which can be treated if necessary.

The tell-tale sign of an experienced surgeon is how cognizant they are about preserving these structures.  Here at C/V ENT Surgical Group in Los Angeles, the surgeons are quite concerned with preserving these structures and they go to great lengths to identify and intraoperatively monitor the recurrent laryngeal nerves so that they minimize any trauma to the nerves or parathyroid glands.  They also are unique that they can perform Minimally Invasive Thyroid Surgery utilizing a 1.5 to 2 inch incsion in most cases to perform either a hemithyroidectomy or total thyroidectomy.  Only a few surgeons in the country do these procedures with excellent results, such as our surgeons.

As the thyroid gland is quite an intricate gland, pathology can arise within it when nodules, cysts or other disorders such as Grave’s disease or Hashimoto’s thyroiditis occur. Nodules are solid masses that occur within the gland and cysts are fluid-filled masses.

Nodules and cysts are not uncommon findings among the general population as they occur in up to 7% of adults in the USA. Although the majority of these nodules, over 80%, are benign in nature, all masses within the thyroid gland warrant further attention as a minority will turn out to be cancerous.

The usual workup of a thyroid nodule or cyst is thyroid function tests (labs) and a thyroid ultrasound followed by fine needle aspiration (FNA) of the suspected lesion to determine if it appears benign or is concerning for malignancy. If deemed benign the lesion may be observed for any changes with serial exams or ultrasounds, however if found to be suspicious then a diagnostic hemithyroidectomy may be performed.

Rarely if the mass is found to be malignant on FNA, then a total thyroidectomy is performed from the start. A hemithyroidectomy is where half of the gland is removed and intraoperatively looked at by pathologists to determine if the nodule is malignant. If the mass is definitively found to be malignant in the operating room, then a total thyroidectomy is performed right then and there. If it cannot be determined at that time, then the patient is closed up and the patient will follow up in the office one week later for the final pathology results. At that time if the mass is found benign, then no further surgery is warranted, however if it is found to be malignant then the patient is brought back to the operating room for a completion thyroidectomy to remove the other half of the thyroid gland.

When a hemithyroidectomy is performed there is no reason to monitor calcium levels or place the patient on thyroid hormone replacement. However, when a total thyroidectomy is performed calcium levels are monitored postoperatively to make sure the patient’s levels do not get so low that it can lead to problems and the patient is placed on thyroid hormone replacement, which is a single pill that is taken daily. The usual stay in the hospital for a patient who has undergone hemithyroidectomy is anywhere from 6-24 hours whereas for total thyroidectomy it is 24 hours. The usual time taken off work by most patients who undergo these surgeries is one week.

The patient will follow-up one week after surgery to review their pathology results and check the wound. In cases where a total thyroidectomy is performed and the mass is deemed to be malignant then the patient will also follow-up with their endocrinologist to arrange for radioactive iodine ablation of any residual microscopic thyroid cells usually a few weeks after surgery. This is all that is required in the majority of cases of thyroid malignancy. Remember thyroid cancer remains to this day to be one of the most curable cancers in the world with a greater than 90% cure rate.

Furthermore, Dr. Alen Cohen was recently named Director of the Minimally Invasive Thyroid Surgery Program at West Hills Medical Center, the only center serving the San Fernando Valley, Los Angeles and Thousand Oaks areas.  To schedule a consultation with Dr. Cohen please call the office at (818)888-7878.

View gallery of patients post thyroid surgery