Non Robotic Videoscopically Assisted Facelift (Retro-Auricular) Approach to Hemithyroidectomy in Selected Cases
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- Category: Vol. 82, March 2014
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Non Robotic Videoscopically Assisted Facelift (Retro-Auricular) Approach to Hemithyroidectomy in Selected Cases, ALAA M. EL-ERIAN
Abstract
Background: Facelift (retro-auricular hairline incision) approach is a valuable remote access thyroidectomy approach to eliminate neck scar, however, it is described with the use of the very expensive high technology of robot assistance that is unavailable everywhere and requires extensive training.
Aim: Is to explore the feasibility of facelift approach to thyroidectomy in a non-robotic way with only videoscopic assistance.
Patients and Methods: 15 patients with solitary thyroid nodule with a mean age of 29.66±7. 1 y, F:M=4:1 underwent facelift thyroidectomy. Inclusion criteria were; solitary thyroid nodule <4cm, young females preferring absence of a neck scar, benign FNAB, thyroid cyst indicated for hemi-thyroidectomy, Normal vocal cords function on laryngoscopy. Exclusion criteria were: Previous neck surgery or facelift surgery, substernal extension, bilateral lobe lesions, associated cervical lymph node enlargement, evidence of thyroiditis, severe morbid obesity (BMI >35). A surgical pocket is created by raising a subplatysmal flap from a retro-auricular hairline incision till the midline of the neck. The pocket is maintained with the use of long bladed retractors and the thyroid gland is exposed by opening the carotid triangle and dividing superior belly of omohyoid. The gland is devascularised and retrieved under videoscopic assistance with the use of ligasure device and conventional laparoscopic instruments. Procedural assess-ment is achieved by recording operative and postoperative data.
Results: The operative procedure succeeded in all cases with no conversion to cervicotomy approach. Time of creating the surgical pocket was 33±3.3m and total operative time was 106±12m. RLN was identified and safeguarded in all cases, SELN was identified in only 8/15 cases, and at least one parathyroid gland was identified in all cases but both glands were identified in 9/15. In none of the cases lobe rupture or fracture occurred. None of the patients developed laryngeal nerve injury or Hypoparathyroidism and in none neck visceral or major vascular injury occurred. Intraoperative blood loss was minimal, postoperative haematoma occured in two cases and seroma in another two. In none flap necrosis or wound infection occurred, however, keloid scar occurred in only one case and hairline alopecia in another one. Postoperative pain was well tolerated, mean VAS score=2.8±2 at 6 hours and 2.3±2.1 at 24 hours. Ear parathesia occurred in two patients. Mean hospital stay was 48,8±13. 1. All patients were satisfied and pleased with good to excellent cosmesis.
Conclusion: Facelift thyroidectomy is feasible and safe in a non-robotic way under video-assistance with the use of high energy activated devices, conventional laparoscopic instruments and long bladed retractors.