Ordinarily, surgery to remove part of a patient’s thyroid leaves a scar on the neck. But Stanford surgeon Dana Lin performed the procedure by going through the mouth.
June 5, 2019 - By Mandy Erickson
Karina Torres was worried last year when she learned she had papillary thyroid cancer, and it didn’t help to hear that surgery to treat the condition would leave a scar on the front of her neck.
The hair stylist, makeup artist and massage therapist had undergone surgery before and felt she had enough scars. “A scar on the neck — that’s something you can’t really cover up,” she said.
Torres, 44, traveled from her home in Fresno, California, to Stanford Hospital to receive a second opinion about her tumor from Dana Lin, MD, assistant professor of surgery at the School of Medicine. Lin told her that the tumor was small, so Torres was a candidate for a new type of surgery: transoral thyroidectomy, or removal of the thyroid through the mouth, which wouldn’t leave a visible scar.
“I offered it to her, and explained that she would be our first patient,” Lin said. “She was excited about it and wanted to pursue it.”
‘I was comfortable with it’
Torres said she wasn’t concerned about being a patient pioneer. “I knew Dr. Lin would be there with another specialist who had done the procedure before, so I was comfortable with it,” she said.
A Thai physician developed the transoral thyroidectomy in 2014 and published an article about it in 2016; since then, the procedure has spread to a handful of medical centers in the United States. To learn how to perform the surgery, Lin reached out to Insoo Suh, MD, assistant professor of surgery at University of California-San Francisco, who has completed about 25 of the procedures.
I’m very grateful to not have a scar.
She observed Suh perform the surgery at UCSF, then practiced the technique on cadavers. When it came time for Torres’ surgery, which took place April 16, Suh guided Lin through it. Robin Cisco, MD, an assistant professor of surgery at Stanford who had observed the procedure in Thailand, also aided with the surgery.
First, Lin made three small incisions inside Torres’ lower lip, openings through which she inserted a scope with a video camera and two surgical instruments: a grasping tool and a cutting tool. The camera’s images appeared on several screens in the operating room.
Watching the screens, Lin guided the scope and instruments underneath the skin, downward over Torres’ chin and along her neck to the thyroid gland. She cut away the left half of the gland, where the tumor lay; placed it in a little bag; and pulled the bag out through the mouth. Suh stepped in only occasionally to ensure Lin was finding her way correctly.
The whole procedure took about four hours, though Lin said she expects the time to drop as she becomes more practiced with future surgeries.
‘Minimal pain and discomfort’
Torres “did fantastic post-operatively,” Lin said. “She had minimal pain and discomfort and was discharged the next day.”
The benefit of having a transoral thyroidectomy is mostly the lack of scarring, Lin and Suh said. They added that data show the procedure is at least as safe as the traditional, through-the-neck route. It’s possible the transoral procedure has other benefits, such as decreasing the risk of nerve injury, which can affect a patient’s voice, and causing less pain after surgery, but more study is needed.
Lin said the procedure is especially beneficial for patients who develop keloid or hypertrophic scars, which are red, raised and more noticeable. Transoral thyroidectomy will not work for patients who have large tumors or goiters, as they won’t fit through the surgical ports.
Recovering at home after the surgery, Torres said she was a little sore, but felt relieved that the surgery went well.
“I’m very grateful to not have a scar,” she said. “I can’t see myself wearing scarves all the time, especially in hot Fresno.”
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