1060 - Horizontal lateral thyroidectomy “Thomas technique” a novel surgical approach to thyroid neoplasms

Date 28 September 2012
Event ESMO Congress 2012
Session Publication Only
Topics Thyroid Cancer
Surgery and/or Radiotherapy of Cancer
Presenter Thomas Varughese
Authors T. Varughese
  • Oncology Dept., LAKESHORE HOSPITAL AND RESEARCH CENTER,, 682040 - Cochin/IN

Abstract

Background

Kochers' anterior approach is the universal standard for thyroidectomy but with several complications. Feasibility of horizontal lateral thyroidectomy (Thomas' Technique,) based on 3 D volumetric anatomy is a novel concept to minimize complications to the superior, Recurrent Laryngeal nerves, Para thyroids and vessels which are posterior and lateral. Unique anatomy of platysma, safeguarding of sub platysmal venous plexus and investing layer of deep fascia in relation to Cosmetic outcome is highlighted.

Objectives

This feasibility study was designed to avoid all the known complications of thyroidectomy and an unaesthetic anterior scar.

Methods

Superior results from the pilot study, prompted to extend the study for the next 2 years.

Of 283 subjects thus enrolled, 231 were females and 52 males. 118 had benign disease out of which 75 were MNGs, 31 adenomas and 9 cysts. Out of 165 Cancers, 160 were differentiated (96papillary, 44 follicular, 20 mixed and 5 medullary).18 had intra thoracic extensions. Using single ipsilateral incision 40 hemi thyroidectomies, 70 total thyroidectomies of benign and 55 total thyroidectomies of early cancers were done. Bilateral approach used in 110 cases of carcinomas requiring bilateral node dissection and for 8 benign cases of bilateral intrathorasic extensions. Para thyroids were dissected pulverized and injected into Sternocleidomastoid muscle before dissection if required.

Results

Blood loss was 10-15 ml and hospital stay 24 hrs. There were no nerve injuries. Parathyroid deficiency was reported in 10/283. 165 thyroidectomies (115 totals) were performed with single lateral incision. Within 6 months scar disappeared, touch sensations returned to normal. Cosmesis and quality of life were excellent.

Conclusions

“Horizontal lateral thyroidectomy”–”Thomas technique”, is a novel method applicable for all thyroid neoplasms. Avoidance of “handling” of the gland upfront, direct vision of nerves, and ligation of vascular pedicles upfront leading to an avascular gland makes this approach unique and “bloodless”. It facilitates better lymph adenectomy and is safest for hemi as well as Total thyroidectomy and for intrathorasic extensions. Complications described in the literature are minimised. Superior cosmetic results compared to Kocher's technique.

Disclosure

All authors have declared no conflicts of interest.