Dr. Emad Kandil of Tulane University School of Medicine is one of the first in the country to perform a new form of endoscopic surgery that uses a small incision under the arm to remove all or a portion of the thyroid or parathyroid glands without leaving a scar on the neck. Not only is Dr. Kandil one of the few surgeons in the US trained to perform the surgery, but he chairs an annual symposium at Tulane to teach surgeons how to perform minimally invasive thyroid surgery and will be teaching the technique to doctors from across the country.
Traditional surgery usually involves a fairly long incision at the base of the neck. The new Robotic transaxillay approach means that the patient won’t have a scar on the neck, and for many people, this is enough to try this novel technique.
Robotic gasless transaxillary thyroidectomy is a newly developed minimally invasive surgical technique to remove all or part of the thyroid. This was developed by Dr. Chung in South Korea. With this new technique, a small incision is made under the arm. Before its development, there were different options for thyroid surgery: conventional open surgery, endoscopic surgery with a shorter neck incision or transaxillary approach with gas insufflation. Conventional open surgery involves a scar on the neck. Endoscopic or videoscopic techniques are done using a small camera, however, this still involves a neck scar. The neck scar is shorter in these approaches, but still there is an incison in the neck. With the new method, there is no scar on the neck whatsoever.
Robotic gasless transaxillary thyroidectomy eliminates the neck scar by accessing the thyroid gland through a hidden incision under the arm. The special designed robotic arms allow the surgeon to operate with very precise movements. Robotic instruments do work just like hands. However, they are amazingly small. The robot is completely under the control of the surgeon. The robotic system also proides 3D visualization, with a special designed high-definition camera with an excellent magnification of 10x.
This technique is not only about avoiding an incision and a scar on the neck. From a surgical standpoint, safely performing these procedures depends on clear visualization of important nearby structures, including nerves and parathyroid glands.
Initially, robotic approach was done with gas insufflation to the neck area, however this gas can be retained, which can cause retained pneumomediastinum or subcutaneous air with uncomfortable crepitations. The patient may experience significant metablic problems with CO2 retention. The gas eventually will be absorbed, but it can cause siginificant discofort until this completely absorbed. These patients needed to stay hospitalized longer than they used to with conventional surgery for observation. With this new approach, gas insufflations is avoided, so Co2 retention complications are also avoided.
This procedure was recently approved by FDA and is is proven to be a safe approach. However, special training and experience with robotic surgery is a must to proceed. With more experience, more patients can be offered this approach. Large thyroid nodules over 4cm were initially not candidates for this procedure before, however, now the surgery is able to be offered to these patients with an excellent outcome.
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