To compare the surgical outcomes of robotic selective neck dissection (SND) with total thyroidectomy and conventional transcervical SND with total thyroidectomy. Comparison of apron incision outcomes with MEK incision. Objectives: Access to the thyroid compartment has traditionally been achieved by a Kocher incision followed by subplatysmal flap elevation and strap muscle retraction. Older high-risk patients had a survival benefit with total thyroidectomy and lymph node dissection. Participants Modified extended Kocher incision for total thyroidectomy with lateral compartment neck dissection - a critical appraisal of surgical access and cosmesis in 31 patients. All anterior and lateral neck lymph nodes associated with surrounding fibrofatty tissue were dissected and removed, preserving both sternocleidomastoid muscles and internal jugular veins. Removal of thyroid: Based on the type of thyroidectomy – the procedure may be repeated on the other side as well, Your email address will not be published. Mean length of the incision was 5.5 cm for total thyroidectomy, 4.6 cm for lobectomy, and 3.5 cm for parathyroidectomy (P<.001). Kocher incision to the shortest 15 mm access achieved with Minimally Invasive Video-Assisted Thyroidectomy. Preoperative ultrasound‐guided FNAB is a reliable method for detection of positive lymph nodes in sublevel IIa in comparison with the definitive histopathological analysis. Objectives: Access to the thyroid compartment has traditionally been achieved by a Kocher incision followed by subplatysmal flap elevation and strap muscle retraction. Lobectomy on one side + Subtotal thyroidectomy on other side. adequate access and minimizing cosmetic deformity. Retraction of strap muscles: Away from thyroid, 6. All patients had total thyroidectomy, central neck dissection (level VI) and selective neck dissection (level II‐ V). We compared the operative results, cosmetic outcomes, objective scar measurement, and sensory disturbance between the two groups. Sixty patients (80%) had positive, Pharyngocutaneous fistula is a serious complication following total laryngectomy. To investigate possible metastasis predictors for neck sublevel IIb in papillary thyroid carcinoma with lateral neck metastasis and to determine the reliability of preoperative ultrasound‐guided fine needle aspiration biopsy (FNAB) as a method of detecting positive lymph nodes in sublevel IIa in comparison with the finding of definitive pathohistological analysis. However, 'scarless' (in the neck) endoscopic thyroidectomy, consisting of endoscopic and robotic surgery, is progressively being adopted for its perceived cosmetic benefits. This incision is indicated for radical lymphadenectomy and may be combined with other neck surgeries. involvement. Single center study Demographic, socioeconomic status, scar perception and an adapted body image scale were evaluated to identify factors that shaped the patient's perception of the surgical approach. Highest clinical significance has positivity of sublevel IIa. study with patients with proven lateral neck metastases from papillary thyroid carcinoma at the time of initial diagnosis. For his work he received, amon… Since the first endoscopic parathyroidectomy was performed in 1996 [1], minimally invasive endoscopic or robotic approaches have been Further study with a larger number of patients is mandatory. The Kocher incision (1 in ) is centered over the Fig. when necessary either a unilateral or bilateral LCND (4, 5, 6, 7). Ipsilateral level V LNM was significantly associated with tumor size >10 mm, extrathyroidal extension, ipsilateral central LNM ratio ≥50%, and contralateral central LNM (CLNM), bilateral CLNM, and simultaneous levels II-IV LNM. Potential predictive factors for the occurrence of metastasis in sublevel IIb were analyzed. Papillary thyroid carcinoma in low-risk patients had a favorable prognosis regardless of treatment. The impact of these metastases on outcome depends on the histological subtype and the size, number and location of those metastases, as well as patient’s age. Mobilization of thyroid and ligation of vessels in series: Your email address will not be published. Methods 1. Type of neck dissection did not affect recurrence or appearance of distant metastases. When treated with total thyroidectomy and routine postoperative iodine 131 ablation, patients with well-differentiated thyroid carcinoma who present with neck node metastases outside the central compartment of the neck have an approximately 6-fold risk of developing recurrences, most of which occur in the neck. Conclusion: Thyroid cancer metastasizes to regional lymph nodes early and often. Of the 727 patients, 585 (80.5%) were classified as low risk and 142 (19.5%) as high risk. The use of a MEK incision allows adequate access to all levels of the neck, minimizes the. The median age of patients with neck disease was 3 years younger than those without neck disease and most had papillary carcinoma. Kocher incision: ( kō'kĕr ), an incision made several inches below and parallel to the right costal margin. Mobilization of thyroid and ligation of vessels in series: Superior followed by inferior. Arch Otolaryngol Head Neck Surg, 128;825-828. Twenty-year survival in low-risk, younger high-risk, and older high-risk patients receiving radioactive iodine vs no radiation was 100% vs 97.6% (P =.24), 64.2% vs 73.2% (P =.53), and 44.7% vs 44.4% (P =.53). The utilization of smaller incisions during MIT often requires excessive retraction to gain adequate exposure to the thyroid. Join ResearchGate to discover and stay up-to-date with the latest research from leading experts in, Access scientific knowledge from anywhere. An interviewer-administered survey was conducted. Technique: Total Thyroidectomy Step 1: Incision Location . Predictive factors for the occurrence of metastasis in sublevel IIb that have reached statistical significance are: positive sublevel IIa, number of positive lymph nodes and positive levels IIa+III+IV+V. Methods: Ten patients with thyroid or lip carcinomas were submitted to unilateral or bilateral neck dissection through a transverse supraclavicular neck incision. Head and Neck Surgery, 3rd Floor Southwark Wing, Guy’s Hospital, St. Thomas’ Street, London SE1 9RT, UK. This robotic surgery uses a small incision in the patient's armpit to operate on the thyroid. In conventional thyroidectomy, a skin-crease collar incision (Kocher incision) is used approximately two fingerbreadths above the sternoclavicular joint in neck extension. Case series with chart review. The surgeon who embarks on neck dissection for DTC must therefore be knowledgeable about the patterns of neck metastases from thyroid cancer and competent to resect all clinically significant disease—while identifying, protecting, and preserving all vital structures within the lateral neck. Ligation of middle thyroid vein: 1st vein to be ligated, 8. Background The traditional Kocher operation is characterized by a 10– 12cm long skin incision which results in a visible large scar in the neck. However, this method produces a scar on the anterior neck resulting in poor cosmetic outcomes. The most common procedure is Mac Fee radical neck dissection, which is usually performed through an extended collar incision 3 cm above the clavicle extending to the posterior edge of the sternocleidomastoid muscle, combined with a second parallel transverse middle neck incision (1). The number of harvested and metastatic lymph nodes, Vancouver Scar Scale scores, and sensory change were not significantly different between the two groups. total laryngectomy with pharyngeal resection and neck dissection. Results: A single low transverse incision may provide equivalent surgical outcomes and superior cosmetic outcomes compared with the hockey stick incision for LND in PTC. Conclusion: Main Outcome Measure Survival. By the turn of the century, the basic techniques and principles of thyroid surgery had been established. Patients with thyroid carcinoma were also submitted to a total thyroidectomy during the same procedure. Guy's and St Thomas' NHS Foundation Trust, Low transverse incision for lateral neck dissection in patients with papillary thyroid cancer: Improved cosmesis, Single Supraclavicular Transverse Incision for Radical Neck Dissections, Preoperative scar perception study comparing ‘scarless’ in the neck endoscopic thyroidectomy with open thyroidectomy: a cross-sectional study, Comparison of Robotic versus Conventional Selective Neck Dissection and Total Thyroidectomy for Papillary Thyroid Carcinoma, Modified Neck Dissection for Differentiated Thyroid Cancer, Management of regional nodes in Thyroid Cancer, Surgical management of advanced differentiated thyroid cancer - Introducing the concept of wide field total thyroidectomy: How we do it, Impact of Nodal Metastases on Prognosis in Patients With Well-Differentiated Thyroid Cancer, Management of the Neck in Cancer of the Major Salivary Glands, Thyroid and Parathyroid Glands, Predicting Outcome and Directing Therapy for Papillary Thyroid Carcinoma. On univariate analysis, disease-free and overall survival rates were significantly lower in patients who presented with neck node metastases (P<.001 and P =.005); this difference in survival remained highly significant on multivariate analysis for disease-free survival (P =.001), with a relative hazard of 6.27. This rather large interval encompasses many different possible technical choices, even if we just consider open surgery. The dissection of the central compartment or level VI should be part of the procedure of total thyroidectomy for proven differentiated thyroid carcinoma in selected cases. It produces hormones that regulate every aspect of your metabolism, from your heart rate to how quickly you burn calories.Thyroidectomy is used to treat thyroid disorders, such as cancer, noncancerous enlargement of the thyroid (goiter) and overactive thyroid (hyperthyroidism).How much … Objective: Clinical otolaryngology: official journal of ENT-UK; official journal of Netherlands Society for Oto-Rhino-Laryngology & Cervico-Facial Surgery. The conventional cervical incision, or Kocher incision, has been the traditional approach to thyroidectomy since it was first introduced by Theodore Kocher in the latter part of the 19 th century (1). Conclusion Mean total operative time was longer in the robotic group than the conventional group (298 vs 236 minutes; P < .001). Lymph node metastases occur early and often in papillary thyroid cancer, the most common differentiated cancer of the thyroid gland. The treatment of choice for well-differentiated thyroid cancer in young patients is total thyroidectomy. To describe unilateral and bilateral modified radical neck dissections with access to the thyroid gland and all neck lymph node levels through a single supraclavicular transverse incision. Tertiary care center. The classical Kocher incision for thyroid surgery, which is approximately 10 cm long, has been the gold standard for more than a century. The purpose of this study was to compare the surgical and cosmetic outcomes of a single low transverse incision with the hockey stick incision for lateral neck dissection (LND) in patients with papillary thyroid carcinoma (PTC). He made major contributions to the fields of applied surgery, neurosurgery and, especially, thyroid surgery and endocrinology. In this review article we discuss the lymphatic drainage of the thyroid gland, and assessment of regional lymph nodes. Thyrotoxic storm (in cases of toxic glands). Older high-risk patients had a survival advantage with bilateral thyroidectomy: 54.7% 20-year survival for those undergoing bilateral thyroidectomy and 25.0% for unilateral thyroidectomy (P =.004). However, subjective satisfaction with the scar and neck contour was higher in the low transverse incision group compared with the hockey stick incision group.
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