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Scarless thyroid surgery

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A presentation on the latest technique to remove the thyroid gland; via the transoral route. This novel technique is a form natural orifice trans-endoscopic surgery (NOTES) and is truly scarless. Comparisons with the traditional open and other remote endoscopic techniques are explored.

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Scarless thyroid surgery

  1. 1. Scarless Thyroid Surgery Chea Chan Hooi MD, MS, FMAS, DMAS, CMIA, AMM Borneo Medical Centre (Miri)
  2. 2. Content • Anatomy • Function • Clinical features • Investigations • Treatment options • Medicine • Surgery • Radioiodine • Q&A
  3. 3. Anatomy • Butterfly shaped • 30 - 50% of population have pyramidal lobe • Goitre = enlarged thyroid gland
  4. 4. Function • Cardiac • Increase heart rate • Increase cardiac output • Respiratory • Increase respiration rate • Biochemical • Increase basal metabolic rate • Increase protein and carbohydrate metabolism • Nervous system • Potentiates brain development • Increase sympathetic activity • Reproductive • Increase endometrial thickness
  5. 5. Classification of thyroid disorders • Anatomical • Solitary nodule • Dominant nodule of MNG • Multinodular goitre (MNG) • Diffuse goitre • Functional • Hyperthyroidism (↑) • Hypothyroidism (↓)
  6. 6. History • Compressive symptoms • Malignancy component • Risk factors • Red flags • Cancer spread symptoms • Thyroid status • Hyper or hypothyroidism symptoms • Past thyroid or neck surgery
  7. 7. Graves eye signs NO SPECS Class 0 None Class 1 Only signs (lid retraction ± lag) Class 2 Soft tissue (conjunctival & lids edema, injection) Class 3 Proptosis Class 4 Extraocular muscles involvement Class 5 Corneal involvement Class 6 Sight loss (usually CNII)
  8. 8. Tests • TFT • TSH • T4 • T3 • Antibodies • Anti-TPO • Anti-Tg • Thyroglobulin • ECG • CXR • CT scan
  9. 9. Treatment options • Cancer • Surgery • Radioiodine • Hyperthyroidism • Medical • Radioiodine • Surgery • Thyroiditis • Medical • Less is more
  10. 10. Thyroidectomy - removal of thyroid • By extent Hemithyroidectomy
  11. 11. • Open • Via collarneck incision • Endoscopic •Facelift incision approach •Breast-axillary approach •Transoral
  12. 12. Facelift approach
  13. 13. Breast approach
  14. 14. Transoral thyroidectomy
  15. 15. Possible complications General • Bleeding • Infection • Hoarseness of voice • Surrounding organ injury Specific • Chin numbness • Lip asymmetry
  16. 16. Advantages • No visible scar • Minimal skin area dissected, less bleeding, less infection, less thickening Disadvantages • New technique • Not for huge goitres • Potential contamination by oral cavity bacteria • Numbness at chin
  17. 17. Patients who are not suitable • Previous radiotherapy to neck • Previous neck surgery • Goitre extends into chest • Goitre stuck to other organs • Needs extensive lymph node dissection • Nodule > 6cm
  18. 18. ?
  19. 19. Conclusion • Goitres are common • Beware of red flag symptoms that suggest malignancy • Surgery had always been a main treatment option for goitres • Transoral thyroidectomy avoids a visible neck scar • Transoral thyroidectomy is the next frontier in thyroid surgery
  20. 20. TQ! Q&A?

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