Robotic Thyroid Removal

None — The Thyroid Gland

The thyroid gland is a butterfly-shaped structure in the front of the neck, just under the Adam's apple/voice box. The gland is responsible for the production of two main hormones: thyroid hormone (controls heart rate, body temperature, weight and blood pressure) and calcitonin (helps regulate calcium levels). Behind the thyroid gland there are four smaller glands, called the parathyroid glands. These structures make parathyroid hormone, which regulates levels of calcium in the body.

Thyroid Nodules and Cancer

Thyroid nodules are lumps in the thyroid gland. A majority of thyroid nodules are benign. But about one in 20 (5 percent) is cancerous. Potential signs of thyroid cancer include: pain in the front of the neck, changes in the voice or voice hoarseness, problems with breathing or swallowing, swollen lymph nodes and persistent cough.

The American Cancer Society estimated about 37,200 new cases of thyroid cancer would be diagnosed in 2009. Roughly 1,630 Americans were expected to die from it. Thyroid cancer tends to affect younger adults, with most cases diagnosed between 20 and 60. Women are affected three times more often than men. Some other risk factors include: low levels of iodine in the diet, exposure to high levels of radiation and family history of thyroid cancer, nodules or goiter (enlargement of the thyroid gland). Thyroid cancer is typically very curable if detected early. Average five-year survival rates are about 97 percent.

Surgery for Thyroid Cancer

The main treatment for thyroid cancer is surgery. The extent of surgery depends upon the size of the tumor, type of cancer, location and spread. In a total thyroidectomy, the surgeon removes all of the thyroid gland. Nearby lymph nodes may also be removed as well as some surrounding tissue. A lobectomy is the removal of one half (lobe) of the thyroid gland and the center strip of tissue that connects it with the other lobe.

After surgery, some patients receive radioactive iodine therapy to destroy any remaining cancer cells. Once the thyroid gland is removed or destroyed, the body isn't able to make the thyroid hormones. Patients need to take thyroid replacement medication for the rest of their lives.

A New Technique

Traditionally, a thyroidectomy is performed through an incision in the neck. Patients are sometimes reluctant to have the surgery because they don't want the visible neck scar. Some physicians remove the thyroid through minimally invasive surgery (using several small incisions). However, these incisions can leave small scars.

Ronald Kuppersmith, M.D., Surgeon with Texas ENT and Allergy in College Station, TX, is one of a growing number of physicians performing thyroidectomy through a different route, by making an incision in the underarm area. Next, a tunnel is created between the skin and muscles to get to the neck. Then, using tiny surgical instruments, the thyroid gland is cut free and removed. Kuppersmith says he occasionally needs to make a small incision in the chest to provide better access.

By going through the underarm area, the incision is mostly hidden from view. Patients typically only spend one night in the hospital. There is minimal pain after surgery, though patients will experience some soreness for several weeks after surgery.

The underarm approach to thyroid removal is possible because of the use of a surgical robot, called the da Vinci system. The robot holds the surgical instruments while the surgeon sits at a console and guides the robotic arms. Kuppersmith says the robotic technique gives the physician a three-dimensional view inside the body and more precise control/improved dexterity with the surgical instruments.

The underarm thyroidectomy takes extra training for surgeons. Doctors must become competent with use of the da Vinci robot and the underarm approach to gain access to the thyroid gland.

For general information on thyroid cancer:

American Cancer Society American Thyroid Association National Cancer Institute

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