What Makes Robotic Thyroid Surgery Better for Thyroid Goiters?
Robotic thyroid surgery provides the surgeon with a better view of the thyroid and surrounding tissues. We call this "exposure" of the operating field. Adequate exposure (a better view all around the goiter) is essential for safe resection of your thyroid goiter. Compared to the normal thyroid glands which are generally 4-6cm in length and 1.5-2cm in thickness (3 inches by 1 inch on each side), thyroid goiters can measure up to 12cmm in length (5 inches) and be much more round or fuller. In other words, something smaller than a golfball becomes bigger than a softball. Therefore, acquiring adequate working space and full exposure of the goiter is important in safe thyroid surgery.
Traditional Thyroid Surgery Leaves a Large Neck ScarFor traditional open thyroid surgery, the skin incision is extended side to side and the muscles surrounding the thyroid are also opened vertically up and down to give the surgeon the exposure he/she needs and to accommodate the goiter. Such large incisions on the skin and traction can cause significant swelling on the neck. Subsequent scarring can cause significant thickening along the neck incision and adhesions. Also, large muscle incisions under the skin can cause a very thickened “healing ridge". Some people get keloids which are ugly thick scars.
To maintain adequate exposures, a significant traction force is applied to the skin which often leads to poor wound healing and scarring during the traditional open thyroid surgery. Despite this, the view may be compromised due to the fact that large goiters will be obscured the view of important structures such as the recurrent laryngeal nerve which runs underneath the goiter.
In robotic scarless thyroid surgery, adequate working space is acquired all underneath the skin through the same four small incisions... the instruments go through the incisions so the surgeons hands don't have to! Depending on the size and the location of the goiter, the workspace under the skin can be extended just big enough keeping the surgery minimally invasive and yet the skin stays intact and there is no scar in the neck.
Once the full exposure has been achieved, the remaining steps of the surgery are very similar to the traditional open surgery. However, a notable advantage is the enhanced visualization. The camera is ideally placed under the thyroid goiter to visualize the important structures such as the recurrent laryngeal nerve and parathyroid gland. The positioning of the camera makes all the difference in robotic scarless thyroid surgery. It generates a view that the open thyroid surgery cannot where your surgeon stands beside you looking down on the neck. Also in robotic scarless thyroid surgery, there is no traction or pressure-related trauma to the skin and surrounding tissue so the neck tissues heal faster and with less pain.
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Robotic Surgery Lets Your Surgeon Perform BetterRobotic scarless surgery is also advantageous in that it can provide stable traction of the goiter so the surgeon has much better exposure with consistent pressure without fatigue or tremor. Such an advantage provides an opportunity for the surgeon to focus on the refined dissection on the nerve and other important structures without using one of his/her hands retracting the goiter itself (one of the robot arms will do that). Traction induced recurrent laryngeal nerve injury is the most common type of nerve injury during thyroid surgery. Also, robotic arms may lack a tactile (touch sense) feedback, improved visualization with stable traction provide very optimal exposure and safe dissection of the nerve. Robotic arms are precisely controlled by the surgeon but also by the computer software and advanced mechanical regulations.
The bottom line... Robotic Scarless Thyroid surgery is well suited for small as well as large goiter resection. Especially the bilateral axillo-breast approach (BABA) scarless robotic thyroid surgery is most advantageous in that it offers the most extensive surgical options with wide exposure, readily expandable working space, advanced instruments for ideal maneuverability of the goiter, stable traction of the goiter, and optimal visualization with the 3D high-definition camera.
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