The minimally-invasive thyroidectomy incision: A histological analysis

Abstract

SummaryBackgroundMinimally invasive thyroidectomy (MIT) has gained popularity in the surgical management of benign and malignant pathology of the thyroid. One of the main benefits of utilizing this technique is the use of smaller incisions resulting in increased cosmetic satisfaction. Unfortunately, the retraction required for adequate exposure during MIT may lead to skin damage, impaired wound healing and poor cosmetic outcomes. Some have proposed that excising incision edges prior to closure may improve cosmesis. A review of the literature does not reveal any histologic evidence to support this technique.Material/MethodsIn this prospective observational study, nine subjects undergoing MIT were identified. Both the superior and inferior skin edges were excised and labeled for orientation. Specimens were sent for hematoxylin and eosin staining and histologic analysis by a staff pathologist.ResultsAll specimens showed no significant findings such as damage to the architecture of the dermis, acute inflammation, edema or evidence of hemorrhage. Focal blood vessel ectasia within the dermis was identified in three of nine subjects.ConclusionsOur findings do not yield a histological basis supporting the routine trimming of incisions during MIT. Although no significant findings were noted histologically, further studies are warranted to investigate the long-term cosmetic outcome of MIT incisions.

Cosmesis and Body Image after Minimally Invasive or Open Thyroid Surgery

“…Furthermore, the retraction required for adequate exposure and the augmented need for preparation from incision sites far from the neck (e.g., axilla or breast) during these procedures may lead to augmented skin and tissue damage. This can result in impaired wound healing and, in some cases, poor cosmetic results [28]. In a recent review, it was concluded that ''scarless'' (in the neck) endoscopic thyroid approaches via the axilla, anterior/breast, and a hybrid (anterior combined with axilla) comes at a steep price by being maximally invasive in other areas and involving longer operative times and greater postoperative pain [29].…”

Minimally Invasive Video-Assisted versus Minimally Invasive Nonendoscopic Thyroidectomy

“…However Perigli et al in their study did not find any difference in the postoperative pain, as well as in cosmetic result and hypoparathyroidism in the groups of MIVAT and MINET surgeries [ 23 ]. Furthermore no histological changes in structure of the scar were found when comparing specimens of different retraction forces [ 24 ].…”