News Article: Robots preclude neck incision for thyroid surgery

Original article here: Robots preclude neck incision for thyroid surgery

Robots preclude neck incision for thyroid surgery

AUGUSTA, Ga. - Robots that revolutionized gynecologic and urologic surgery in the past decade now offer the option of removing at least a portion of their diseased thyroid gland without the hallmark neck incision, researchers said.

The thyroid, which sits just under the Adam's apple and controls the body's metabolic rate, is about the size of a kiwi. Benign and cancerous disease can more than double its size. Dr. David Terris, Porubsky professor and chairman of the Medical College of Georgia Department of Otolaryngology-Head and Neck Surgery, has helped shepherd in minimally-invasive approaches that reduced neck incisions from several inches to less than an inch within the last few years.

The daVinci Surgical System, in which surgeons sitting at a console maneuver through tight spaces and around corners, enables access to the thyroid through the armpit, Terris said.

"In my opinion, if you are committed to not having a neck scar, this is the best way to do it," Terris said of patients who are trim, have benign disease and need only half of their two-lobed thyroid gland removed.

He and his colleagues – Dr. F. Christopher Holsinger, associate professor at the University of Texas MD Anderson Cancer Center, and Dr. Ronald B. Kuppersmith, clinical faculty member at Texas A & M Health Science Center – provide an overview of the robotic technique they are helping develop in the United States in the current print edition of Otolaryngologic Clinics of North America.

Although the armpit is farther from the gland than the neck is, simply raising the patient's arm during surgery shortens the path, leaving a fairly straightforward approach made navigable by the three- dimensional visualization and wrist-like maneuverability of the robot.

"The robot is what makes it possible to easily – and safely – do the work from that distance," Terris said. Surgeons gain access through a two-to-three-inch armpit incision, then work their way through skin and fat and finally in between two big neck muscles. "It's a long way down a big tunnel to get to that thyroid through the armpit that would not be possible without telescopes and long instruments," he said.

In the August 2004 edition of Laryngoscope Terris advocated the technique for select patients after comparing five minimally invasive approaches in pigs. While acknowledging that the armpit approach is a lot more work in humans, experience has enabled Terris to complete the procedure in less than two hours vs. under an hour via a three-quarter-inch neck incision.

Korean surgeons have the most experience to date with robotic thyroidectomy in humans and are using the approach to remove both lobes, Terris said, noting that cultural concerns about neck scars helped push Koreans to be pioneers in the field. He thinks improving technology will hasten the procedure's acceptance in the United States, where robotics in other medical procedures are already common.

In the journal article, the thyroid surgeons recommend that colleagues interested in the approach should complete robotics training, practice thyroid removal on cadavers, watch an experienced surgeon use the technique, then have a surgeon watch them.

"I Don't Know"

This morning hasn't gone well so far.

Knowing I was waking early this morning, my intentions for an early night last night were dashed when I found myself still messing around online after midnight...this is getting to be a real pattern with me, and I can't seem to break it. I can't get up in the mornings, and I can't seem to get to bed before 2am at night.

Undeterred I set my alarm an hour before I wanted to get up, so I could swallow my Eltroxin and go back to sleep...so far so good...but then I got tormented by the snooze setting on my alarm. And so my plans of waking serenely and enjoying coffee and breakfast before heading to the doctor for the next round of blood tests, was replaced by a mad panic of realising I was still in bed and needed to be heading out the door in less than 5 minutes...eeeek!

It never seems to go to plan, but the receptionists at the surgery are very discreet, and they almost never comment on my bed hair, or the toothpaste dribbled down my front, so I think I got away with it again.

But I was still firmly in sleep-land during my appointment...I didn't cop that my doctor only took one vial of blood this time, until it was too late, and I was already holding down the cotton wool on the recently violated vein, so she could put in the strip of sticky tape over it. Which means I'll *only* get my thyroid panel done this time...with not a clue of any of my other blood indicators.

I also completely forgot to mention the dizzy spells I've been getting...and when she asked me how I was feeling all I could muster was "I don't know"...which is of absolutely no use to man nor beast! I had it all prepared...what I wanted to discuss with her, the dizziness, the neck stiffness, the *up* days, where I'm raring to go on everything and fit to burst with ideas and activities, and the *down* days, where I couldn't even tell you my name because my head is so foggy....and all I managed to say was "I don't know"....very profound!

I did remember to mention the stitch/infection issue on my scar, which is looking heaps better since I stopped using the Bio Oil, and instead bathed it in Savlon Antiseptic Wound Wash Spray twice a day. And she did have a little dig about with the piece of stitch still evident, but stated there wasn't enough there for her to get hold of and do something with it. She said the dissolving stitches normally take around 4 weeks to dissolve, and if it was still there in 2 weeks time then she would investigate it further for me...I have a horrible feeling that may well involve a dab of local anaesthetic and a scalpel, but I didn't ask. She said to continue with the Savlon Spray if it flared up again...and to stay away from the Bio Oil until she said it was OK to try it again.

Then, to add insult to injury, when I went to pay my fees at reception I realised I had no cash. and there was no cheque book in my handbag. I sheepishly said I'd nip into the nearby village and get some cash out...to find the only shop in the village with a cash machine had it removed 2 weeks ago...so back to the surgery, with an even more sheepish "I'll pop the money in the post"...

Am I still over-exhausted from the stupidly busy, but extremely fun weekend I've just had, or am I in thyroid brain fog hell....you have until Friday to guess, because that's when I'll get today's test results back, and all with be revealed, ha!

A stitch in time...

...but how much time? How long does it take for dissolving stitches to dissolve?

At either end of my scar I can just about feel what feels like a tiny piece of fishing line. Now I'm sure my surgeon didn't use fishing line, he assured me he'd used dissolving stitches, both internally (obviously!) and externally...and that I could just ignore them, they'll go in time....but how much time.

Hubby kept insisting I was imagining it, we both stared and peered at my scar, but couldn't see anything...but if you brush your finger gently across the scar you can definitely feel the stub end of the aforementioned article, that I'll just call fishing line, one bit at each end of the scar.

So how long until they disappear?

Back to my GP next week for another pre-Endo blood draw, so if they are still in evidence then I'll get her to investigate.

I'm having a mixed response to the Bio Oil. I will of course keep going with it, and I hope that in a few months time I will be absolutely singing its praises to the highest...but my observations for now are both good and bad.

On the one hand, it seems to make the scar sore immediately after I apply it...the soreness is only temporary, and not all *that* sore if I'm honest, but it definitely results in soreness where there was no soreness prior to application. Is this just because the scar is getting direct physical attention for the first time in 3 weeks? Or is the evidence of some possible left-over stitches a sign that I shouldn't be using the oil yet, ie the site is not totally sealed yet?
But on a more positive note, it seems the gentle massage of the area, during application of the oil, gives instant results in improved neck mobility. I find the scar gets tight, and my neck gets stiff, both overnight and as the day wears on, and yet as soon as I've given it some gentle attention with the Bio Oil, the scar feels much less tight and I can turn my neck to the left and right with a lot more ease.

In other news...I finally got the Wii Fit out again, and had an enjoyable 30 minute session on it this morning. I know I mentioned starting again with it a couple of weeks ago, but when the crunch came down I just didn't feel up to it. But I was delighted to find a lot of my regular exercises weren't nearly as difficult or painful as I expected them to be. If anything, I could do most stuff, but obviously took it easier on some of the games. I struggled with anything that involved holding my arms above my head, that really seems to pull on my neck, and some of the more obscure yoga stretches weren't achievable because I was afraid of straining my neck. However I still had a satisfactory session, and worked up a good sweat!

Bio Oil for Scars

Yesterday I was given the all-clear by my surgeon to start using Bio Oil.

Many, many people have recommended it for helping to drastically reduce scarring (as well as improving the appearance of stretch marks and uneven skin tone).

Because he used dissolving stitches, and thus I didn't have to go and physically get my stitches taken out, I wasn't sure when to start using it...and my pharmacist had warned me that because Bio Oil is very thin I mustn't use it until the wound was totally sealed...so I waited until my surgeon said it was OK to use it.

Today is the day. Thanks to my lovely Mum I have a 200ml bottle on hand to get started with. And I reckon Amazon looks pretty competitive, price-wise, for sourcing any subsequent bottles I may purchase.

And here, gore fans (and I reckon its safe now for non-gore fans) is the latest scar pics, taken yesterday, 24 days after my thyroidectomy.


You can find out more info on Bio Oil here: www.bio-oil.com

And here's a link to Bio-oil on Amazon

Farewell to my Surgeon

Went back to hospital today for my post-op follow-up with my surgeon (yes, I know I was only there on Tuesday, to see my Endo - but that's how these guys roll I guess)

I was called in to the consultation room by his registrar, but then Mr S himself came in to have a peer at my neck.

They both stated that they thought it looked good, and was healing very well.

Apparently its perfectly normal to have good days and bad days, with regards to stiffness, pain and the tight feeling...that its all part of the healing process, where its all healing internally at different rates. And it'll probably continue to feel like this for a good while yet.
The remaining swelling was minimal, and the scar site itself they both declared looked excellent.

They reiterated that I need to keep the site protected from the sun at all times. That it will take up to a year before the scar heals completely and becomes strong, but that within a couple of months it should be barely noticeable.

I was given the all clear to start lashing Bio Oil on it, and we all bid a fond farewell to each other as my surgeon declared that as far as he was concerned I was all finished with his ENT department. But, should there be a further complication down the road (highly unlikely), all my Endo had to do was pick up the phone and Mr S would put me straight back on his patient list.

I thanked him profusely for all he had done for me. The more I looked into the horrors others have experienced after Thyroid surgery, the more truly appreciative I had become of my surgeon and his skills. (I did a bit of Google stalking - and have to say he comes extremely well recommended and appears to be very highly respected in his speciality by his peers!).
Post-op I had no numbness, no tingling. No obvious deterioration in my voice or vocal chords (other than initial soreness form being tubed during the op). No problems with my parathyroids, or calcium levels, either temporarily or permanently. And none of the other awful things that are known risks of this type of surgery, which have happened to others, and which my Fuzzy Thyroid Brain won't allow me to recall right now...

Oh, and one more bit of good news...they send a sample of the goitre/thyroid gland for a histology report as standard during the op...and mine came back *BENIGN*. Thyroid Cancer is one of the most common reasons to do a total thyroidectomy, but was never in question in my case. My thyroidectomy was due to my toxic multi nodular goitre, which, in addition to raising merry hell with my thyroid levels, was closing on my windpipe and slowly strangling me....but even so, hearing the word *benign* will surely always give someone a little lift!

Farewell Mr S, you're diamond!

Too Much Too Soon

"Two things are infinite: the universe and human stupidity; and I'm not sure about the universe" - Albert Einstein, Physicist

I was more than a little dumb this weekend.

Cabin fever was driving me up the walls, and buoyed up by my reasonably successful driving adventure on Friday....the opportunity to go camping near the Cork / Limerick border with friends Saturday night was too hard to resist.

And now I'm really sore....simply too much driving, far too soon. The muscles at the side of my neck feel incredibly tight, I can barely move me head, my oesophagus is complaining rudely at even swallowing water, and my chin and throat area are very tender to touch.
Don't even start me on the totally self-inflicted sunburn....I managed to keep the main wound area covered over with a light scarf...but that did nothing to protect my shoulders, which are glowing as I type!

But sure, for views like this, I'll suck up a little extra pain any day!


In other news...I'm still jumping on the scales religiously every Monday morning, even though I'm not currently, consciously dieting (read: eating very badly, if I'm honest!), or really doing any exercise of note...and combined with the fact that I'm currently hypO...I was mystified, and somewhat delighted, to note that I have lost 2lbs in the last 7 days...if only it was this easy when I *am* dieting and exercising properly...

Beautiful Scar

“There is something beautiful about all scars of whatever nature. A scar means the hurt is over, the wound is closed and healed, done with.” - Harry Crews, American Writer & Novelist

Not sure I'd class my scar as beautiful just yet...but I think that quote is wonderful!

And here are my updated scar pics, taken on Tuesday, 15 days after my thyroidectomy:




The red marks around the chest drain hole are just where the dressing plaster has been sitting. The swelling has gone down significantly, and my husband is no longer making jokes about my surgeon mistakenly leaving his mobile phone in there!

Singing in the Shower

Thanks to my multi-talented husband, we finally have a fully-functioning shower, with hot water & everything!

Its only taken 2½ years to get it fixed....but initially we waited for our landlord to get on it and sort it out. After a while we decided it was going to be an expensive job to fix, and thus less likely to ever be sorted by the landlord...then I guess we just got used to using the bath instead. And one day we realised it had been over 2½ years since the shower last worked...

But since the operation, getting into and out of the bath was out of the question. Amazing how many neck muscles you use doing something like that, truly! And washing my (very long) hair in the bath was impossible.

So hubby went to war on the shower, ordered a few likely parts...and whilst we waited for those to be delivered, my local campsite very kindly allowed me to use their showers.

But last night, I had my first shower, in over 2½ years...in my own home! Bliss :)

--

In other news my scar is starting to look and feel better, and during a dressing change on my chest drain hole I sneaked a peak at the 'hole' for the very first time (I was far too squeamish before!), after hubby expressed surprise at just how good that looked too after he took the old dressing off.

[the chest drain hole is the dark smudge about an inch below the main scar]

We've decided to leave the dressing off during the day, to let the air at it for a few days...and just replace the dressing at night, so I don't inadvertently do something stupid to it during my sleep.


As an aside, I was chatting to a friend this morning, who's a paramedic, about my concerns regarding my current meds and the chances of being run over by a bus [no they're not related! although with thyroid brain fog any thing's possible?].
And I asked him if I ought to keep a card or something in my wallet, regarding the medication I'm taking...and he reassured me that all the info they needed, in the rare case that an emergency case cannot communicate, is my name and DOB or next of kin...and the rest would be dealt with by the computer systems. He said in his experience the ICE method doesn't work, as generally at the scene of an accident the paramedics have better things to do than scroll through someone's mobile phone looking for an ICE number. If it would make me feel better, I could stick a note in with my meds, but it'd be far more handy to just have hubby's details written somewhere prominent, especially as my meds and dosages are liable to change.

Out & About

Had a mini trip into town this morning...not sure it was wise in hindsight, but I was very glad to get out and do something, even if it made me feel absolutely shattered and extra-wobbly for the rest of the day.

Of course it was one of the hottest days we've had, so I felt a right wally staggering around town with a scarf wrapped around my neck. In hindsight, perhaps the 'freak-stares' that my scar would have earned would have been preferable to the sweaty, beetroot face I presented to the public instead.

But its Mum's birthday on Monday, so not trusting hubby's card-buying or present-buying abilities, I lost them in the supermarket, and went off to do some secret shopping.

Of course, all this had to wait until the after-effects of taking Eltroxin (see yesterday's blog) had done their worst, and my dose of Imodium had kicked in and started working...ho hum!

I know you're just dying to see how my neck looks now, so here you go gore-fans:

Hospital food, and TV wars!

[posted retrospectively & not necessarily in order - 1st June, day after the op]

At some point in the afternoon I was moved to a semi-private room, where I shared with another girl. She'd just come back after developing some problems a week after tonsil surgery.
She proceeded to hog the TV remote control, stuck it on mute, then when Desperate Housewives came on later that evening I had to endure it at top volume (when she was discharged the next morning, the very first thing I did was grab the remote control from the side of her bed!)
I was still too tired & spaced to bother with resurrecting any sense of fairness over the TV availability, so I just plugged the iPod into my ears, and watched the moving pictures until Mum and Hubby turned up during visiting hours.

I still wasn't eating very much. I'd forced down a yogurt for breakfast, under great duress from stern-looking nurses. I accepted some soup for lunch, but couldn't get past one mouthful.
Don't get me wrong, I know hospital food doesn't generally have a great reputation world-wide, but I was pleasantly surprised by the variety, tastiness and quality of the hospital food I was given. When my appetite did return I really enjoyed each and every meal. But for now, I just wasn't hungry.

At some point during the morning they emptied the vacuum pump on my surgical chest drain. Overnight it had sucked lots of blood & goo out of me, and I was now becoming more aware of this hose sticking out of the front of my chest. They kept calling it a tube, but it certainly felt like a ruddy great hose! And it was really starting to be a very sore pain-in-the-arse. I had a little clip on the container, so when I went off for walkies ( the nurses were adamant that I should be marching laps of the hospital on a very regular basis - what happened to rest & recuperation?) I could clip the vacuum container-thingy onto my clothing...and thus I could march about, with my lovely container of blood and goo on full public show, hanging off the lapel of my dressing gown...nice!

My surgeon came around at some point in the morning, to tell me how pleased he was about how it had all gone. He apologised for the size of the scar, but said it was as small as he could manage, given the size of the goitre.

Roughly every 6 hours, day & night, a vampire came visiting (different one each time) stealing lots of blood from my poor right arm, and disappearing off with a swish of their cape.
On the strength of these visits I was kept informed of the fact that despite being a Grave's Hyper patient my calcium levels hadn't dipped at all, but that they would continue to monitor them, We all concurred that this can only be due to the sterling work I had been doing with my Endo's Senior Registrar over the last few months, chipping away at my carbimazole dose, ever so slowly, so that for the first time in over 2½ years my blood levels not only come down into range, but had also stayed in range for over 6 weeks. My surgeon had explained to me that the more Hyper I was at the time of the operation, the more my calcium would crash as my body went into instant withdrawal. So thanks to Dr. R and his endless patience and gentle ways, we were pretty much as good as it gets on the day of the operation. But also many thanks to my surgeon, for having a steady hand and not harassing my parathyroid glands whilst he was in there digging about with his scalpel, as that was another common cause of a calcium crash.

Late in the afternoon new girl moved into the bed next door. She was brought in with stomach pains, and put on our ward for observation as there were no beds available on the general wards. We got on great, and came to a mutually beneficial agreement over the TV Remote. She made me laugh so many times, and listened carefully when my mother joined the nurses in nagging me to go walking. She made it her mission to take me off for random walks around the place, as and when she'd decided I'd been laying around too long. If you ever read this, and recognise yourself as that girl, well, thanks J, you were a star!

Meanwhile mum and hubby, when they weren't being doting relatives beside my bed, and listening to my alternating mumbling, croaking & whingeing, were amusing themselves between the 2 shifts of visiting hours, by shopping lots in the local shopping centre and sampling all the muffins in the coffee shops they found!

A friend of mine worked on a neighbouring ward, so she kept me sane too, by popping in whenever she got a chance to make sure I was OK and had everything I needed. She helped break up the long, slow mornings between drug rounds, vampire visits and blood pressure checks. Thanks N, you rock too!

And just for the gore-fans amongst you, here are some pics of my neck and chest drain, taken less than 24 hours after the operation...absolutely no idea what I had to smile about....I was sore, woozy, uncomfortable & grumpy - it must have been a morphine-induced smile, is all I can say! :)