Thyroid

surgery by
mini-incision
Rosemary Hardin MD, J oelle Pierre MD,
and George Ferzli MD, FACS
SUNY Downstate
Medical Center
Lutheran
Medical Center
A review of our method of thyroid
surgery via mini-incision, first
published in JACS (Journal of the
American College of Surgeons, May
2001).

G Ferzli, P Sayad, Z Abdo, R Cacchione Minimally invasive, non-endoscopic thyroid surgery.
J Am Coll Surg May 2001: 192 (5) 665-668
An incision is made along a
skin crease high up in the neck.
Superior and inferior
subplatysmal flaps are
developed.
The superior pole vessels are
approached first, from a medial
to lateral direction, staying close
to the capsule to avoid the
external branch of the superior
laryngeal nerve
(*Amelita Galli-Curci*,
Julie Andrews?)
* Injury to the Superior Laryngeal Branch of the Vagus During Thyroidectomy: Lesson or Myth? Peter F. Crookes,
MD, FACS and James A. Recabaren, MD, FACS From the Department of Surgery, University of Southern California Keck
School of Medicine, Los Angeles, California
Delivery through the wound, of the upper
pole of the thyroid with medial rotation, will
allow a view of the laryngotracheal
junction.
Rt. recurrent laryngeal nerve
Tubercle of Zuckerkandl
Rt. upper parathyroid gland
At the laryngotracheal
junction, identify the
following structures:
Middle thyroid vein
ligated and divided
The inferior pole vessels
are divided
If total thyroidectomy, repeat
steps on left side
Free trachea from thyroid by
dividing ligament of Berry
Ligament of Berry
Thyroid gland
is delivered
easily
through the
wound
PATIENTS
264 thyroid surgeries on
256 patients
55 men and 201 women
Age 17 to 95 years (48)
PREOP DIAGNOSIS
Mass or nodule = 176
Goiter = 74
Hyperthyroiditis = 6
Type of procedures:
5 nodulectomies
78 R lobectomies
65 L lobectomies
30 near total
86 total thyroidectomies

Lymph node dissection
6 patients

Length of incision:
2 cm. = 52
2.5 cm. = 32
3 cm. = 68
4 cm. = 98
> 4 cm. = 14
Total 264
Of the 256 patients, 8 who initially underwent
unilateral thyroid lobectomy subsequently required
resection of the contralateral lobe (completion
thyroidectomy using the same incision)
OR TIME
27 164 (48.59)
(dropped from an average of 76 in
2001 in the first 89 patients)

HOSPITAL STAY
Outpatient = 26 patients
23 hours = 210 patients
Two days = 18 patients
> Two days = 2 patients
COMPLICATIONS
Arrhythmia = 1 patient

Hematoma (reop) = 1 patient
(R thyroid)

Open wound (near total) = 1 patient

Inadvertent
parathyroidectomy = 3 patients

Hypocalcemia = 3 patients
(2 requiring readmission)

Nerve injury
Recurrent laryngeal = 3 (2 transient, 1 permanent)
POST OPERATIVE PATHOLOGY
WEIGHT 4530 gm. (50.05)
PATHOLOGIES
Follicular adenomas 68
Papillary carcinomas 53
Multinodular goiters 38
Colloid nodules 11
Hashimotos thyroiditis 25
Mixed papillary-follicular carcinomas 4
Follicular carcinoma 10
Lymphoma 1
Graves disease 2
Medullary carcinoma 2
Chronic lymphocytic thyroiditis 2
Hurtle cell cancer 6
Nodular hyperplasia 34
TOTAL 256
CONCLUSION
Thyroid surgery using mini-incision is
feasible and safe

Done on an out-patient basis

Can be attempted on any thyroid pathology

Can be performed under local anesthesia

Compared to endoscopic thyroid surgery,
it has a shorter operative time, shorter
hospital stay, comparable cosmetic results
and no complication related to neck insufflation

Completion thyroidectomy, when required, can be performed
through the same incision

It has an excellent cosmetic result