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Transoral Thyroid Surgery: Who's the Best Candidate for Scarless Transoral Thyroid Surgery?

Transoral thyroid surgery is a great option for some patients who have a small thyroid nodule or mass who don't want a large scar on their neck. This page will discuss who is the best candidate for transoral thyorid surgery, and who would be better served by a robotic scarless thyroid surgery. These are two very different operations.

Who is the Best Person to Have Scarless Transoral Thyroid Surgery?

Scarless thyroid surgery is for any patient who is interested and motivated in avoiding a neck scar. If you have a history of raised or thickened scar or keloid, you should also consider the scarless technique. There are two different types of scarless thyroid surgery and this page discusses the technique of transoral scarless thyroid surgery. The transoral technique is best suited for benign (non-cancerous) thyroid disease and small thyroid cancer that is well contained within the thyroid gland. For a selected group of patients, removal of the entire thyroid gland can be considered, however, most of these patients would be better served by having a robotic scarless thyroid operation. As always, it is important to discuss the indications for surgery, the extent of the surgery (half/lobe vs. total), and the different types of scarless thyroid surgery techniques. Since these are very new techniques with less than a dozen surgeons in the US performing more than 5 per year, it is very important for you to chose a surgeon who does lots! Dr Suh performs more than any other surgeon in the US, and he understands the indications and contraindications very well.

Transoral Thyroid Surgery for Benign Thyroid Nodules

For patients with benign but symptomatic or large nodules, you may be an ideal candidate for transoral scarless surgery. Although your nodules may be benign based on the needle biopsy, you may be experiencing compressive symptoms such as swallowing difficulties, throat irritation, cough, or shortness of breath. Typically, once the nodule becomes over 3-4 cm, you may be experiencing a compressive symptom depending on the location and the firmness of the thyroid nodule. Also, once a single nodule grows over 3-4 cm, surgery may be recommended for concern for incidental cancer. In other words, there could be hidden cancer within that large nodule.

Transoral Thyroid Surgery for Thyroid Nodules Suspicious for Thyroid Cancer

Transoral thyroid surgery may be a very good option for patients with suspicious nodules based on the ultrasound findings or a needle biopsy of a thyroid nodule. After a fine needle biopsy of your thyroid nodule, if the diagnosis came back as an “indeterminate” nodule meaning it is not benign or definite cancer, but having a significant risk of cancer, you may need surgery for diagnosis and transoral thyroid surgery could be a great option. In this case, your biopsy report may state Bethesda classification 3 or 4. Also, your doctor may have ordered additional testing known as a molecular or genetic test to further assess for cancer risk. If your overall risk is elevated, you will need a thyroid resection and you would be a candidate for transoral thyroid surgery. Typically, one-sided surgery (lobectomy) would suffice.

Transoral thyroid surgery may be also suitable for small thyroid cancer (<2cm) without any evidence of cancer extension beyond the thyroid gland or concern for an invasion of the surrounding tissue. Also, if you have a proven cancerous or concerning lymph nodes for a thyroid cancer spread, transoral surgery may not be suitable.

Transoral Thyroid Surgery for Hashimoto's and Grave's Disease

If you have a known or long-standing autoimmune disease such as Hashimoto thyroiditis leading to chronic inflammation can pose significant challenges and may not be suitable for scarless techniques. These cases are better treated with the robotic scarless thyroid surgery technique. Also, if you have uncontrolled or refractory hyperfunction of the thyroid gland (hyperthyroidism) from Graves disease, you should almost always chose robotic thyroidectomy instead of transoral thyroid surgery.

If you have an active infection in the mouth including tooth abscess, gum infection, ulcers, or sores, transoral surgery will not be suitable. Any infections should be treated prior to proceeding with surgery.