Overview
“Scarless” thyroidectomy (or transoral thyroidectomy) is a technique that removes the thyroid gland without leaving a visible scar on the neck. This procedure involves hiding incisions inside the lower lip, similar to the way that keyhole incisions in the abdomen are used for laparoscopic gall bladder surgery. It is an excellent option for patients who are concerned about the cosmetic appearance of a neck scar. Also, studies have demonstrated that patients who have scarless thyroid surgery may have a slightly better quality of life a few years after thyroid surgery. And patients are more than 3x less likely to be self-conscious about the skin of their chin or neck if they have scarless surgery.
If you are worried about maintaining healthcare privacy after having surgery, avoiding a scar on your neck could be for you. Choosing when and how to disclose a medical condition becomes the patient's choice if there is no scar to alert the world.
The Russell Center, and Dr Jon Russell specifically, have done more "scarless" transoral thyroidectomy and transoral parathyroidectomy cases than any other surgeon in the Western Hemisphere. Complication rates are equivalent to traditional surgery, and quality of life is slightly better when patients choose a transoral "scarless" thyroidectomy.
Procedure
During “scarless” thyroidectomy, the surgeon makes small incisions inside the lower lip to access the thyroid gland. Specialized instruments are used to remove the gland through these incisions (with or without a robot to help). The procedure is performed under general anesthesia and usually takes an hour or two. Transoral thyroidectomy and parathyroidectomy avoids any external incisions, leaving no visible scar on the neck.Transoral thyroidectomy can be done to remove half of the thyroid (hemithyroidectomy) or all of the thyroid (total thyroidectomy). It can be done for cancer, Graves' disease, goiter, and most other conditions that require surgery. In fact, most patients are eligible for "scarless" thyroidectomy and parathyroidectomy. Check out our video about scarless thyroid surgery for more information!
Benefits and Risks
The primary benefit of “scarless” thyroidectomy is the absence of a visible scar. The scar is the number one complaint of patients after thyroid surgery, with about 80% of patients expressing concerns about the appearance of their scar in one recent study completed by surgeons in Chicago. Benefits of "scarless" surgery according to some studies include a quicker recovery time and reduced postoperative pain compared to traditional surgery. As with traditional thyroid surgery, potential risks include infection, bleeding, and damage to the surrounding structures such as the recurrent laryngeal nerve and parathyroid glands. These risks are the same whether patients choose the scarless surgery or traditional surgery. There are several unique risks to the scarless surgery, but these risks (chin changes, numbness, infection) have not been identified regularly in a large number of research studies to date. Your health is always our priority at the Russell Center. If scarless thyroid surgery is not right for you, we will let you know.
While at Johns Hopkins, Dr Russell extensively researched the topic of how scars impact a patient's quality of life, including approximately 100 papers, books and chapters on the topic. As part of this research, he has taken before and after pictures of patients and asked more than 2000 patients about their quality of life after thyroid and parathyroid surgery. Ultimately, the results have consistently agreed with the results of other researchers: avoiding a scar improves the quality of life of most patients.
Recovery and Follow-Up
Recovery from “scarless” thyroidectomy is usually the same as with traditional surgery, with most patients able to return home the same day or after an overnight stay. Mild discomfort in the chin and neck is common and can be managed with over-the-counter pain medications. It is important to follow postoperative care instructions to ensure proper healing. After surgery, you will schedule a follow up appointment with your endocrinologist or primary care doctor to check your thyroid function. We will schedule an appointment with our office (either virtual or in person) after surgery to check in and review pathology. Because many of our patients travel to see us, it is important to make follow up as simple as possible. Fortunately, most of our patients will go home the same day, and complications are very rare. For that reason, patients are generally able to travel home shortly after surgery. Virtual follow up visits can be an efficient way to check in when patients are interested.
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