I. Scarless lumpectomy thyroid tumor removal in the neck
Scarless lumpectomy thyroidectomy in the neck basically meets the aesthetic requirements of most patients. With the development of high-tech surgical instruments and the increasing pursuit of beauty, surgeons began to explore the application of lumpectomy technology to thyroid surgery in order to achieve the exact therapeutic effect and the best aesthetic and minimally invasive effect. This has led to the creation of lumpectomy thyroid surgery without incisions in the neck. The lumpectomy thyroid surgery takes advantage of the magnification of the lumpectomy image and the use of ultrasonic knife to cut the gland and thyroid blood vessels to avoid bleeding, and the remote operation with slender surgical instruments has changed the tradition of thyroid surgery requiring a direct incision in the neck lesion, making the surgery safer and the incision only the size of a “keyhole”. The incision is only the size of a “keyhole” and is transferred to a hidden part of the body, achieving the aesthetic effect of a bare neck without surgical scars.
The main advantages of lumpectomy thyroid: 1.
1. Same results as traditional surgical treatment.
2. less trauma, less bleeding and faster recovery due to the use of ultrasonic knife and minimally invasive instruments
3. less chance of nerve, vascular and parathyroid damage due to the magnification of the lumpectomy.
4. The greater advantage is that the neck is completely scarless and allows maximum protection of patient privacy. The tiny incision in the anterior chest leaves almost no scar after healing and can be completely covered by undergarments.
The current indications for lumpectomy thyroid surgery include.
1, unilateral or bilateral benign adenomas, cysts and nodules.
2, papillary thyroid carcinoma less than 1 cm in diameter, no invasion of the gland surface, and no enlarged lymph nodes adjacent to the carotid artery in the central group. Contraindications, on the other hand, include a history of surgery or radiotherapy to the neck.
3. suspected malignant masses.
4, large multiple nodules.
5. thyroiditis.
5, pathological obesity; coagulation disorders.
6. hyperthyroidism with normal or mildly enlarged gland size.
Second, thyroid microwave ablation
Heat is a kind of energy that belongs to the category of physics, but it is also often accompanied by the occurrence of chemical reactions in the process. The use of heat energy to promote health and treat disease, as early as around 400 BC by the founder of Western medicine, the ancient Greek physician Hippocrates made a better attempt, such as the use of fire, immersion in warm water baths and other more primitive methods.
With the great development and progress of modern physical technology and electronic technology, thermal therapy has gained a new important position in clinical medicine, especially for the treatment of tumors, changing the situation that chemotherapy and radiotherapy unify the world of non-surgical treatment of tumors. Among them, microwave, radiofrequency and laser are the main heat generating media. Usually, the thermal therapy of tumor is called thermal ablation therapy, thus there are microwave ablation therapy, radiofrequency ablation therapy and laser ablation therapy.
Depending on the implementation route of thermal ablation therapy, it can be divided into percutaneous thermal ablation (without skin incision, with the help of puncture technique), laparoscopic thermal ablation (with the help of laparoscopic orifice), and open thermal ablation (in open abdomen or open chest).
The thyroid gland is the largest endocrine organ in the body and is frequently subject to various diseases, such as hyperthyroidism (hyperthyroidism), hypothyroidism (hypothyroidism), acute bacterial thyroiditis (abscess), subacute thyroiditis (associated with viral infection), chronic lymphocytic thyroiditis (Hashimoto’s disease), nodular goiter, thyroid adenoma, thyroid cancer, thyroid lymphoma, etc.
Thermal ablation for thyroid disease is a method that has gradually emerged in recent years, and most foreign countries apply radiofrequency ablation and laser ablation while domestic countries mainly apply microwave ablation and radiofrequency ablation, which are indistinguishable from each other in terms of technical advancement of equipment and effectiveness and safety of treatment.
The way of thermal ablation treatment for thyroid disease is to puncture the treatment needle to the lesion site through percutaneous puncture technology with the help of high-end ultrasound equipment to accurately display and guide the lesion and the treatment needle. Because the needle is very thin, the puncture path is very minimally invasive, and the ultrasound image monitors the treatment area in real time to avoid over- or under-treatment, it is a minimally invasive treatment with strong technological leadership and scientific innovation. The laser fiber directly transmits laser heat to the lesion, while microwave and RF needles transmit not heat itself, but electromagnetic waves and high-frequency alternating current with the ability to conduct, electromagnetic waves and high-frequency alternating current transform energy into heat in the lesion, and the fresher the lesion tissue is the easier the generation and transmission of heat, and eventually the thyroid lesion is damaged by heat and coagulation necrosis occurs, and the necrotic material is quickly Therefore, thermal ablation treatment does not remove the lesion out of the body, but uses the body’s immune phagocytic ability to dissolve and absorb the damaged lesion tissue, which eventually disappears.
At present, the following thyroid diseases have been confirmed to be suitable for thermal ablation treatment.
Benign nodules: thyroid adenoma, nodular goiter, colloid thyroid retention (also called cysts)
However, the following cases are not yet included in the scope of thermal ablation treatment.
1. hyperthyroidism in adolescence
2. iodine hyperthyroidism
3. inflammatory thyroid conditions (subacute thyroiditis, Hashimoto’s disease easily accompanied by hypothyroidism), unless a tumor occurs in the context of Hashimoto’s disease
4. malignant tumor of the thyroid gland
So, what kind of thyroid nodules need thermal ablation treatment?
It should be emphasized that thyroid thermal ablation therapy is an innovation of technology and a transformation of concept within the scope of surgical treatment, which is a very important complement to surgical treatment. Therefore, the choice of thermal ablation therapy is based on the premise that the patient’s condition requires surgical intervention. On this basis, those lesions that are too small to be touched by the surgeon, those lesions that are too diffusely distributed to be removed by surgery one by one, and those new lesions that occur as a result of scar adhesions in the neck due to previous surgical procedures are the best indications for choosing ultrasound-guided percutaneous thermal ablation therapy.
Thermal ablation of thyroid disease is a reliable and preferred option from the perspectives of minimally invasive, cosmetic, safety and effectiveness. As for whether to choose microwave ablation or radiofrequency ablation, physicians will make a comprehensive judgment according to the size and location of the lesion.
Open radical thyroid cancer surgery
When thyroid cancer is diagnosed and there is extra-peripheral invasion or lymph node metastasis in the neck, no minimally invasive surgical method can replace open radical thyroid cancer surgery. Main indications.
1.Infiltrating papillary carcinoma.
2.Infiltrating follicular head adenocarcinoma.
3.Medullary carcinoma.
Radical thyroidectomy is an extensive resection of the affected thyroid gland and regional lymph nodes in the neck for patients with malignant thyroid tumors.
The scope of surgery depends on the condition of the thyroid tumor and the metastasis of the lymph nodes in the neck. In some cases, only the affected lobe + isthmus is resected; in others, lymph node dissection in the central region is added. The posterior cervical triangle (many authors routinely remove the paraglottic nerve) and submandibular and subchin triangle lymph nodes. If needed, the anterosuperior mediastinum should also be removed. In some cases, only a very thin flap of skin is preserved in the anterior neck and the subcutaneous tissue and the broad neck muscle are removed.
As mentioned above, thyroid disease is complex and each patient has different conditions and different requirements, so the treatment plan is different. So what should you do if you have thyroid tumor? Then choose a doctor you trust and let him help you develop a plan that suits you personally to achieve a good prognosis.