Transoral Endoscopic Thyroidectomy & Parathyroidectomy Without A Visible Neck Scar "Scarless"

A new and innovative approach that uses a few small incisions inside the lower lip. This exciting "Above the neck" approach creates a tunnel around the jaw and into the neck. The most recent remote and hidden approach begins only a few centimeters from the thyroid gland and therefore has a shorter recovery period. Laparoscopic cameras and instrumentation allows for great visualization of the anatomy, which makes the operation safer to perform for both partial and total thyroid operations. A parathyroid exploration can also be performed through this approach. The hidden incisions are inside the mouth and heal quickly. Dr. Harding is one of few surgeons in the United States who has invested in learning this technically challenging operation. He is the first surgeon in the southwest to perform this operation and become proficient in this technique. Like many challenging operations, the technique requires a team approach from the anesthesiologist, surgical assistants, as well as the nurses. It may be only offered in a few hospitals and outpatient settings who have a capable staff, as well as special equipment for this operation.

Not all patients are a candidate for this unique, minimally invasive operation but Dr. Harding will work closely with you to determine if this is the best procedure in treating your thyroid condition.

History Of Remote Access Thyroid Surgery:

Since the late 1990's surgeons around the world have been attempting various approaches to the thyroid gland, to help their patients avoid a visible scar in the lower neck. The standard neck incision is at the base of the neck and extends directly down through the neck muscles. After the surgery, there is a visible horizontal line, which usually heals without marked deformity. After the development of super high-resolution cameras designed for endoscopic operations, surgeons developed many approaches to the neck through non-traditional approaches. These alternative and innovative approaches have been driven by the demand to avoid a neck incision, particularly in patients who heal with pigmented or hyperplastic scars, or even worse, keloid formation. In many cultures, a scar in the lower neck is undesirable, secondary to the stigma of a scar in an area associated with beauty.

The Thyroid gland has been approached by performing surgery through the armpit since 1996. Some techniques involved lengthy incisions, as well as a long tunnel to be created from the axilla up to the upper neck. Few surgeons mastered this approach so the operation was not universally available.

The Da Vinci robot was briefly introduced for the endoscopic technique and Dr. Harding was one of the first surgeons in the country trained in this technique. After he had performed a handful of operations, the Da Vinci company withdrew its support for the operation. The reports around the country suggested that many operations, although performed safely, were not producing equivalent results as the open technique. The reports of some patients having less than all of the thyroid removed, inadvertent nerve injury, and cancer recurrence led to the decision to discontinue performing this coveted approach. A few surgeons continued to offer this approach but Dr. Harding perceived that too much surgery was required and that potential poor outcomes did not justify its use.

Another approach still used today is performed through bilateral breast incision, which involves making a tunnel from the medial breast, over the clavicles and into the neck. This technique avoids anterior neck scars. This approach is called BABA and utilizes incisions at the medial breast and armpit area to hide the incisions. The surgeon can also incorporate the use of the Da Vinci robot. These "below the neck" incisions blend in overtime and are usually in covered areas of the body. Remote but visible scars remain.