By – Dr Akshat Malik, Head & Neck Cancer Surgeon, Max Superspeciality Hospital, Saket, New Delhi
Diseases related to the thyroid are common worldwide. Most of these diseases are benign and not dangerous. About 5 per cent of thyroid disorders can be malignant and need surgical treatment. Non-cancerous swellings or benign swellings may be kept under surveillance. Surgery for these is considered only if the swelling is cosmetically bothersome or if the swelling is compressing the food pipe or windpipe in the neck.
Treatment of thyroid cancer depends on various factors. These include age, sex, size of the lesion, and presence of lymph node metastasis or distant metastasis. Surgery is the treatment of choice in most of the cases. Treatment is tailored to suit individual patients. Surgical excision of the thyroid gland may entail a hemi-thyroidectomy or a total thyroidectomy. In hemi-thyroidectomy only half of the gland on the affected side is removed. In total thyroidectomy, the entire thyroid gland is removed. Besides the removal of the thyroid gland, lymph nodes present in the neck may also require to be removed. If lymph nodes in the chest are also involved then they are removed too.
Common complications associated with thyroid surgery include vocal cord palsy and/or hypocalcemia. If the nerve supplying the vocal cord is injured during surgery or requires to excise due to involvement of the disease then the patient may develop hoarseness of voice. It may be temporary or permanent. Permanent cord palsy may occur in less than 5% of cases. During thyroid surgery, if the blood supply to parathyroid glands (related to calcium balance) is affected then the patient may develop hypocalcemia where the blood level of calcium decreases. This may also be temporary or permanent and may require supplementation of calcium. If a complete thyroidectomy has been done then the patient may require life-long supplementation of thyroid hormone.
What is scarless thyroidectomy?
Conventional thyroidectomy means the thyroid gland is removed by giving an incision in the neck. Scarless thyroidectomy refers to a surgical procedure where no visible or apparent scar comes from the neck. Instead, we access the thyroid gland from a distant location, this can be from behind the ear, from the chest or from within the mouth.
How are these surgeries performed?
As you can understand, we are trying to reach the thyroid gland from a remote location, for this we need certain modifications during the surgery. These can be performed with the help of endoscopic instruments or through a robot. Robotic surgery is preferred in this setting as it allows small instruments to reach inside the neck with good freedom of movement and dexterity.
What is the advantage of robotic surgery?
• No visible scar: As these are performed from a distant site, the scar is not apparent or visible normally. This is more relevant for the cases where we doing the procedure for cosmetic purposes.
• Minimal blood loss
• Magnified view: This allows us to identify and preserve the nerve to the vocal cords as well as the parathyroid. This often means fewer complications and faster recovery.
• Faster recovery
How are these robotic surgeries performed?
These are performed by a trained Head and neck Robotic surgeon. The surgeon uses a surgical robot to perform these cases. The robot has small arms through which fine instruments can go in through smaller incisions and areas. The surgeon operates these from a separate console where he gets a 3-dimensional view of the operating area. The entire surgery is within the control of the surgeon.
How is the recovery following these surgeries?
Following the surgery, patients are able to move around, eat and drink the same day. A drain is placed to allow the blood getting collected inside to come out, it is removed in a couple of day’s time. There is no restriction on the patient regarding diet or activities.