When the thyroid is diseased or cancerous, surgical options may best suit the patient. A thyroid lobectomy removes just one of the lobes of the gland, and it also includes the removal of the isthmus. However, the opposite lobe is not removed. This will allow the gland to continue to produce enough hormones for the body. When a person has a condition such as Grave’s disease, cancer, or a goiter that is compressing the airway, a total thyroidectomy is utilized.
An incision is cut in the lower part of the neck for both the standard thyroid lobectomy and the thyroidectomy. The incisions are typically 3-5 inches. The thyroidectomy is a minimally invasive surgical approach that removes the gland using small incisions. Using an endoscope, scarring and healing times are greatly reduced. Generally, these incisions can be as small as 0.8 inches.
Transaxillary Robotic Thyroidectomy
It is possible to have thyroid surgery with no neck incision. Transaxillary robotic thyroid lobectomies are becoming popular. An incision is made into the armpit. A receptor is placed into the space to create room for the thyroid gland to be removed. An endoscope with a camera is required for precision during this procedure. The magnified visualization of the camera is excellent, and it can be customized. The machine also allows for tremor filtration and fine microsurgical movements. This process will not work on aggressive cancers, large tumors, or where there is inflammation. Both Grave’s disease and Hashimoto’s thyroiditis can cause excessive inflammation. Additionally, obese patients may also have too much swelling for this procedure.
Management of Cervical Lymph Nodes
When cancer is involved, it often spreads to the nearby lymph nodes. The paratracheal lymph nodes are usually the first ones affected. Based upon the AJCC staging criteria, these lymph nodes are a level 6. The pretracheal and prelaryngeal, are the two divisions of the paratracheal lymph nodes. If cancer has spread into the lateral neck., then surgery is necessary. A functional neck dissection, or piecemeal operation, removes all the lymph nodes in the area.
Vocal Cord Paralysis
During surgery, great efforts are made to preserve the nerve that runs alongside the thyroid gland. In about one percent of cases, nerve damage will occur. The damage is temporary in 6-8 percent of those cases. If there is damage to the recurrent laryngeal nerve, then a patient may experience vocal cord weakness or even paralysis. They may also have hoarseness or have a breathy voice.