Smaller scars in alternate thyroid surgery approach

March 24, 2011 9:09:12 PM PDT
Millions of Americans suffer from thyroid problems, and for many, that means surgery and an incision that leaves a scar on the neck.

A new approach offers a more attractive option for some patients.

In the wake of the Japanese nuclear crisis, we have heard a lot about radiation poisoning and thyroid cancer.

In the U.S., the number of diagnosed thyroid cancers has been rising for some time. The cause is not clear, but it leaves many patients facing surgery - also called a thyroidectomy.

An innovative approach means no ugly scar on the neck. Patients are traveling thousands of miles to Chicago to have the procedure done - but is it an option for everyone?

Ann Brickner was a mess. Something was going on, and doctors could not come up with an answer.

"I just wanted to sleep, and my hair is falling out, and my skin is just - I mean, I was crying, and they were telling me I needed antidepressants, and I couldn't clean my house, and I was like: my life is falling apart, literally," said Brickner.

Was it a heart problem, depression or something else?

The problem was finally discovered. Her thyroid gland was practically being strangled by growths or nodules.

"I had no thyroid function whatsoever," said Brickner.

The butterfly shaped organ, located in the neck, is vital to good health because it affects so much in the body.

It produces hormones that regulate blood pressure, heart rate, metabolism and more. When it is not working properly, it can do more harm than good.

Brickner's relief of a diagnosis was quickly followed by the realization that her thyroid had to come out. She scars easily and worried about a nasty incision on her neck.

So she went online and found an alternative approach at the University of Illinois Medical Center at Chicago.

"It's possible to reach some difficult target like thyroid avoiding completely an incision in the neck so you don't have any scar in the neck or any wound," said Dr. Pier Giulianotti of the University of Illinois Medical Center at Chicago.

With the help of the da Vinci robot and 3-D imaging, Giulianotti goes after the thyroid through an incision near the armpit. Using tiny tools he tunnels up to the thyroid and carefully cuts it out.

The result is a scar about 2-4 centimeters by the side of the arm, not on the neck.

Is a less visible scar worth the more complicated path? Giulianotti says this approach is very precise.

"So clear that it is almost impossible to do mistakes," said Giulianotti.

University of Chicago surgeon Peter Angelos cautions patients and doctors not to let something new overtake good judgment.

While he still does most thyroidectomies through the neck, he sometimes will offer the alternative approach.

"I think for the appropriate patient, it's very reasonable to consider," said Angelos.

For a cancerous thyroid he still prefers the conventional surgery.

"Most of the operations that now move the scar from the neck to somewhere else - there's not as much experience, at least in the U.S. in knowing that that's as good a cancer operation," said Angelos. "I'd be very hesitant as a patient to just jump into that without a lot of discussion with the surgeon."

Brickner's thyroid was cancer-free, and that made her choice a lot easier. She flew in from the east coast for the surgery at UIC.

Her scar is healing, and she is relieved that it is nowhere near her neck.

"I would do it again in a second - I really would," said Brickner.

Many surgeons say that depending on the patient, the scar left by a conventional thyroidectomy can be hidden in the fold of the neck.

As for the alternative approach, the robot was recently FDA-approved for this surgery, but it is not yet common.

Other surgeons are also trying different approaches such as going through the back of the ear and even the mouth.

More information

Dr. Pier Cristoforo Giulianotti

University of Illinois Medical Ctr. At Chicago

Peter Angelos

Endocrine cancer