By Mary Beth Nierengarten
CHICAGO -- September 23, 2008 -- For patients who have to undergo a thyroidectomy, very small incisions to remove the thyroid can be used even for the majority of patients who undergo an open, nonendoscopic technique, according to a study presented here at the American Academy of Otolaryngology - Head and Neck Surgery Foundation (AAO-HNSF) 2008 Annual Meeting & OTO EXPO.
"Physicians in private practice or those who are not equipped to do endoscopic surgical thyroidectomies can still perform thryoidectomies with very small incisions safely and with results that are aesthetically pleasing to their patients," said lead author Nilesh R. Vasan, MD, Department of Otorhinolaryngology, University of Oklahoma Health Science Center, Oklahoma City, Oklahoma.
Although surgeons are increasingly using endoscopic thyroidectomies, which require very small incisions (eg, 2.0-0.25 cm) to remove the thyroid, only about 10% to 15% of patients can be treated with this approach and many surgeons are not equipped to use this technique, said Dr. Vasan, who presented the study on September 22.
Therefore, Dr. Vasan and colleagues undertook a study to see if small incisions also can be used in certain patients using an open, nonendoscopic technique, which in the past has required about a 6- to 8-cm incision to remove the thyroid. He specifically looked at the association between patient weight, nodule size, and maximum thyroid diameter, as well as the length of the thyroidectomy incision.
Between August 2004 and May 2006, data were collected and analysed on 32 consecutive patients who underwent thyroidectomy. Data were collected on patient demographics, clinical examination, ultrasound, and operative and pathology findings. Vocal chord movement was assessed both before and after surgery by indirect laryngoscopy. Preoperative assessment was made to all incisions as well as the diameter of the thyroid and/or nodules.
A hemithyroidectomy and isthmusectomy were performed in 27 of the 32 patients. Of the 32 patients, 1 patient (3%) had papillary thyroid cancer and 7 (22%) had compressive symptoms.
The mean age of the 32 patients was 47 years (range, 25-83 years), and 81% were women. Mean patient weight was 88 kg (194 lbs), mean clinical nodule diameter was 3.46 cm (median, 3.65 cm), and mean maximum thyroid diameter was 5.91 cm (median, 5.0 cm). The mean incision size was 5.13 cm.
"This study shows that in my hands, the average incision length for all my patients was only 5.13 cm," said Dr. Vasan, adding that this incision length was even further reduced to a length of 4 cm or less in 47% of the patients.
In the study, mean incision size was found to be correlated to patient weight. Most patients in the study (75%) weighed between 45 and 90 kg (100-200 lbs) and were found to have an incision length of 4.83 cm.
Along with patient weight, maximum nodule diameter and maximum thyroid diameter were also found to be independent predictors of incision size. In a stepwise regression analysis that included these 3 variables, only maximum nodule diameter remained a significant predictor of incision length (P < .0001).
The study also found that the mean incision lengths were about 1 to 3 cm longer compared with the thyroid nodule maximum diameter, both on clinical assessment and gross pathology, Dr. Vasan noted.
"The study also shows that when planning the incision, the incision length can be the same or 1 to 2 cm smaller than the maximum thyroid diameter," he continued.
Dr. Vasan said that for many surgeons such as himself, who almost get obsessed with trying to perform the smallest incision for their patients, these data show that small incisions are possible, safe, and aesthetically beneficial in the many patients who undergo open, nonendoscopic thyroidectomies.
[Presentation title: What Can Determine the Length of a Thyroidectomy Incision? Abstract S156]
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