Located at:

Texas ENT and Allergy
1730 Birmingham Drive
College Station, Texas 77845
979-693-6000
877-377-4ENT Toll-Free
979-693-1900 fax

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No Neck Incisions - "Scarless" Surgery?

While robotic surgery has been safely performed on many patients by our group and other groups around the world, there may be additional and unknown risks relative to traditional approaches. Long-term outcome studies comparing this approach to traditional approaches have not been performed to date. This procedure is currently considered an off-label use of the daVinci® Surgical System by the FDA. It is important to discuss this with your surgeon prior to undergoing this technique.

With over 30 combined years of experience performing thyroid and parathyroid surgery, we were among the first surgeons in the United States to offer this procedure and have one of the largest and longest experiences safely performing this procedure. Surgeons from around the world have traveled to College Station to observe our surgeons perform the procedure and learn the technique.

Thyroid (thyroidectomy, thyroid lobectomy) and parathyroid (parathyroidectomy) surgery has traditionally been performed through a neck incision just above the collar bone. While there have been many refinements to thyroid surgery, some patients continue to be unsatisfied with having a cervical (neck) scar.(1,2,3,4) By approaching the thyroid or parathyroids through an incision in the axillary fold (under the arm) and using the daVinci Surgical System, we are able to eliminate the cervical (neck) scar and reduce post-surgical numbness of the anterior neck. The recovery time for patients is similar to traditional surgical techniques.

Potential candidates for this procedure include: patients with thyroid nodules less than 4 cm in diameter, some papillary thyroid carcinomas, and some follicular thyroid carcinomas.   Additionally, patients with a parathyroid adenoma that can be localized pre-operatively through imaging studies may be candidates.There are many other additional factors that determine whether a patient is a suitable candidate for the procedure.

Surgeons hand and EndoWrist InstrumentThe daVinci® Surgical System, which has been widely adopted for use in prostate surgery, hysterectomy and other surgical procedures, offers superior visualization and instrumentation compared to traditional open thyroid surgery, allowing a complete and safe removal of the thyroid to be performed. The da Vinci Surgical System enables surgeons to perform even the most complex and delicate procedures through remote incisions with precision. With daVinci Surgery, miniaturized wristed instruments and a high-definition 3D camera are introduced through small incisions. Seated comfortably at the daVinci console, your surgeon views a magnified, high-resolution 3D image of the surgical site. At the same time, state-of-the-art robotic and computer technologies scale, filter and seamlessly translate your surgeon's hand movements into precise micro-movements of the daVinci instruments.

Standard laparoscopic surgery uses one single camera and limits a surgeon's vision to a 2-D view similar to watching your television. The daVinci robotic camera consists of two high resolution fiberoptic cameras which, like your eyes, produce a true 3-dimensional color picture available to the surgeon seated at the daVinci console. Magnification of 10x is achieved with these cameras whose position is precisely controlled by your surgeon using a central robotic arm.

Although visually similar to standard laparoscopic instruments, the robotic instruments have the additional advantage of being articulated. This means the instruments not only open and close but also fully turn and twist, allowing 7 degrees of motion. Unlike standard open surgical instruments these instruments are much smaller. Many of the jaws of the tools are shorter in length than your fingernail and about as thin as the edge of a half dollar. This allows very small and precise movements and surgical cuts to carefully dissect out the thyroid from its surrounding structures.

 Intuitive Surgical's da Vinci (Robotic) Surgical System

The daVinci Surgery System cannot be programmed, nor can it make decisions on its own. It requires that every surgical maneuver be performed with direct input from your surgeon. 

 
1. Kuppersmith RB, Salem A, Holsinger FC. Advanced approaches for thyroid surgery. Otolaryngology-Head and Neck Surgery. 2009: 141(3): 340-342.
2. Ikeda Y, Takami H, Sasaki Y, et al. Are there significant benefits of minimally invasive endoscopic thyroidectomy? World J Surg. 2004 Nov;28(11):1075-8.
3. Kuppersmith RB. Robotic Thyroid Surgery - Initial Impressions. ENT & Audiology News. November-December 2009.
4. Holsinger FC, Terris DJ, Kuppersmith RB. Robotic Thyroidectomy: Operative Technique Using a Transaxillary Approach without CO2 Insufflation. Otolaryngologic Clinics of North America. 2010: 43:381-388.