Thyroid Surgery Performed Without Neck Incision, Scar

Removing all or part of the thyroid gland typically requires a 3- to 5-inch incision across the front of the lower neck, but surgeons at the University of Illinois Medical Center at Chicago are using robotic-assisted minimally invasive surgery to remove the thyroid without any visible scar.

"The cosmetic and psychological benefits to patients are evident immediately," said Dr. Pier Cristoforo Giulianotti, the Lloyd M. Nyhus Professor of Surgery at UIC. "Young patients in particular are often concerned about a large visible scar and this technique provides an alternative to traditional surgery."

A surgical team led by Giulianotti, chief of minimally invasive, general and robotic surgery at the medical center, recently performed the robotic thyroidectomy surgery on 27-year-old Veronica Esquinca of Hanover Park, Ill.

Esquinca had a large nodule on the right lobe of her thyroid that was discovered during a routine physical exam. She was hesitant to have traditional thyroidectomy surgery and put off having the procedure until she learned about the minimally invasive option.

"I definitely did not want a scar on my neck," said Esquinca, whose surgery was performed Feb. 4. She was discharged one day after surgery and has resumed her daily activities. The nodule was not cancerous.

Thyroid diseases are among the most common disorders of the endocrine system, affecting almost 13 million Americans, according to the American Thyroid Association.

Using the robotic-assisted da Vinci Surgical System, surgeons can remove the thyroid gland by making one small incision under the patient's right arm and another tiny incision in the chest, eliminating the need for a neck incision.

The surgeon is located at a console located several feet away from the operating table where he controls the movements of 4 robotic arms equipped with an endoscopic camera and surgical instruments. The robot provides 3-dimensional visualization, enhanced magnification and a greater range of motion to locate and remove the thyroid gland in the delicate and narrow space of the neck.

Surgical removal of the thyroid gland is performed when a patient has thyroid cancer, an enlarged thyroid, nodule on the neck, or an obstruction that makes it difficult to swallow or breath.

Complications from the surgery may include decreased function of the parathyroid glands, low calcium levels in the blood, and risk of injury to the larynx or vocal cords.

After the removal of the thyroid gland, patients are usually prescribed oral synthetic thyroid hormones.

Giulianotti has also performed robotic-assisted parathyroidectomy surgery to remove the tiny parathyroid glands located behind or near the larger thyroid gland.

"Robotic thyroidectomy and parathyroidectomy are options for most patients who require surgery for benign or cancerous thyroid disease," said Giulianotti, an international pioneer in robotic general surgery and former president of the Minimally Invasive and Robotic Association (MIRA). Giulianotti has performed nearly 1,000 minimally invasive robotic surgical procedures for diseases of the pancreas, lung, esophagus, colon, stomach and liver.

UIC is a leading institution for advanced applications of robotics to complex surgery, such as liver, lung, pancreas and transplant.