Russell, MD, director of endoscopic and robotic thyroid and parathy-
roid surgery, and assistant professor of otolaryngology, at Johns
Hopkins Medicine in Baltimore, Md., is one of the surgery's pioneers.
He says surgeons make a 1.5-cm incision in the gingival sulcus and 2
stab incisions at the oral commissure. They then tunnel down through
the incisions, dissect around the thyroid and remove the gland
through the central incision.
"It's a great approach, because it doesn't require any additional
instrumentation, and it doesn't take too much extra time over the tra-
ditional surgery" — about 15 additional minutes, says Dr. Russell.
"And patients can still go home same-day. In every way, it's the same
surgery except for no scarring."
Transoral thyroidectomy, however, can be a somewhat radical
adjustment in terms of technique for surgeons. "It's a different skill set
for most thyroid surgeons who are accustomed to using open instru-
mentation," says Dr. Russell. "It lends itself well to surgeons who have
laparoscopic skills."
The learning curve is short — about 10 cases — but high-volume
thyroid surgeons are often booked 2 months in advance, so it's diffi-
cult for them to take on these cases to master this technique. That's
been the biggest hurdle to widespread adoption, according to Dr.
Russell, who champions making the technique more widely available.
"It's better for patients," says Dr. Russell. "Certainly, we've seen very
happy patients [who have the procedure done]."
2. Ablation of thyroid nodules
Guided by ultrasound, the surgeon inserts a radiofrequency probe that
heats up the nodules, which activates the immune system and, over
time, causes scarring and shrinkage of the nodules. The procedure
takes half an hour or less. "[Recovery] is clearly not as quick as it is
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