'Scar-less' robotic thyroid surgery

PHOTO: 'Scar-less' robotic thyroid surgery

SINGAPORE - Even in the hands of a skilled surgeon, an indelible effect of conventional open thyroid surgery is a permanent scar in the lower neck.

The surgical procedure, known as a thyroidectomy, is traditionally performed via an incision in the lower neck to remove growths or lumps within the thyroid gland. But thanks to advancements in robot-assisted surgical systems, it is now possible for surgeons to perform a thyroidectomy without making a visible neck incision.

With conventional thyroid surgery, the incision typically results in a five to six centimetre scar across the lower neck, said Dr Ranjiv Sivanandan, head and neck surgeon at The Thyroid Head and Neck Surgery Centre at Mount Elizabeth Hospitals (Orchard & Novena).

At Mount Elizabeth Hospital in Singapore, surgeons have mastered the art of removing thyroid nodules using state-of-the-art robotic surgical technology, which places the incision in the under arm area, also known as the axilla.

The technique was originally pioneered by South Korean surgeons, and this service has been made available at Mount Elizabeth Hospital since 2010.

The robotic systems provide exceptional 3D visualisation and multi-articulated "wristed" instruments, the systems allows surgeons to perform complex operations in a precise yet minimally invasive manner, said Dr Sivanandan.

Referring to the robotic "arms" used during the robotic thyroid surgery, Adjunct Assistant Professor Tay Hin Ngan of ENT Head Neck Thyroid Sleep Robotic Surgery at Mount Elizabeth Novena Hospital says : "It gives me an extra 'hand', so it's like having three hands in there, as well with a binocular vision."

The robotic system magnifies the procedure with a high-definition camera so surgeons operating on patients get a magnified 3D view of the process.

Adjunct Assistant Prof Tay, said he favours robotic surgery because "it offers better manual dexterity" during the procedure.

Explaining how the robotic thyroid surgery works, Dr Sivanandan said an incision is made in the axilla, creating a pathway to the neck area where the thyroid gland is situated.

"With this technique, the scar is well-hidden along the axillary fold so you won't be able to tell even if the patient wears a sleeveless top," said Dr Sivanandan.

The new robot-assisted surgical procedure takes approximately 1.5 to two times longer to complete than conventional thyroid surgery.

It has other added advantages, said Prof Tay. For patients who are predisposed to unsightly scars, the novel robotic surgical option can make a huge difference in their quality of life.

Patients can go about their daily activities as the incision in the under arm does not pose any problems.

"About 90 to 95 per cent of people who undergo conventional thyroid surgery generally heal nicely, but there is a category of patients who might be predisposed to keloids and no matter how well the surgeon positions or closes the neck incision, they could end up with thick, raised scars," said Dr Sivanandan.

Dr Sivanandan estimated that about a third of his patients, most of who are women in their 20s to 40s, routinely ask if it is possible to undergo thyroid surgery without a neck incision.

"Once you move the scar away from the neck, the patient no longer needs to cover up the area or live with a scar on the neck for life," said Prof Tay.

For patients who undergo the new robot-assisted procedure, the recovery time is similar to that of conventional surgery. Dr Sivanandan said his patients are typically discharged a day after the surgery without any complications.

Your thyroid matters

The thyroid, a butterfly-shaped gland sitting just above the collarbones, is responsible for making hormones that affects your entire body including the heart, lungs, as well as digestive and emotional systems.

Any problems with the thyroid, such as an overgrown thyroid nodule or cancerous growth, can throw your body's systems off balance.

Compared to men, women are five times more likely to develop thyroid nodules, which are growths or lumps in the thyroid gland. About a third of women below 50 years old, and half of those above the age of 60 will develop a thyroid nodule that can be detected by a neck ultrasound scan, said Dr Sivanandan.

In fact, thyroid nodules are so common that it is estimated that as many as three in 10 people might have them, added Prof Tay.

While majority of thyroid nodules are benign and do not cause problems, surgery is typically recommended if a nodule grows over time, is large enough to cause problems or when it is suspected to be cancerous, said Dr Sivanandan.

Dr Ranjiv Sivanandan Consultant, General Surgeon Mount Elizabeth Medical Centre

Dr Tay Hin Ngan Consultant, General Surgeon  Mount Elizabeth Medical Centre