Surgical Milestone: Philadelphia’s First Transoral Thyroidectomy

Otolaryngologists Dr. Christopher Fundakowski and Dr. Elizabeth Cottrill recently performed the first transoral thyroidectomy in Philadelphia.

Otolaryngologists Dr. Christopher Fundakowski and Dr. Elizabeth Cottrill recently performed the first transoral thyroidectomy in Philadelphia at Thomas Jefferson University Hospital. The patient had an enlarged benign cystic nodule on their thyroid that you could see protruding from their neck. Prior to this case, the typical approach would have been a traditional “open” surgery that would leave a visible scar across the patient’s neck. However, with this approach, there is no visible scar, and the patient was discharged home the same day.

We sat down with Dr. Fundakowski to learn more about transoral thyroidectomy and how it differs from traditional surgery.

Why might someone need a thyroidectomy?
There are several different reasons why someone would need a thyroidectomy; such as for thyroid cancer, large nodules which interfere with swallowing/breathing, or an overactive thyroid

What exactly happens during a thyroidectomy?
The patient is completely asleep during the procedure. In the standard approach, there is typically a two-inch incision in the front of the neck. The thyroid gland is located beneath a thin layer of muscles. There are blood vessels to the gland that then need to be clipped. At each corner of the thyroid gland, there is a small calcium regulating gland called a parathyroid gland that the surgeon will identify and make sure not to remove. Before the gland is removed, the surgeon will identify the nerves to the voice box and make sure it is protected. The incision is then closed with sutures.

In the transoral approach, there is a one-inch incision in the mouth behind the lip and no neck incision. The surgeon then uses a camera and longer instruments to get to the gland. The mouth incision is then closed with stitches and there is no visible scar.

Side by side photo showing the results of a traditional and transoral thyroidectomy cases
The left photo depicts a scar from a traditional thyroidectomy three years prior. The right shows a transoral thyroidectomy case.

What does recovery look like from a transoral thyroidectomy?
After a transoral thyroidectomy, there can be some bruising on the neck, just as a traditional “open” surgery and this is typically treated with ice packs. The patients can still eat the same day as their surgery, they just rinse their mouth afterwards. There is no increase in infection risk and safety outcomes are the same as open surgery. Some temporary numbness in the front of the chin is normal.  The patients are also given instructions on neck stretching exercises.

What are some factors that are used to determine candidacy for this procedure?
Patient anatomy, nodule size, nodule location and history of head/neck surgery are the main factors used to determine candidacy. There are about 150,000 thyroid and 100,000 parathyroid cases per year. Based on recent studies, approximately 50% of patients would be candidates for this approach, but there have been less than 500 total cases performed in the US so far in the last three years. So many patient do not know this is available and there are extremely few centers that provide this approach.

Are there any next steps after the procedure?
After a patient has recovered from a transoral thyroidectomy, the standard postoperative follow-up and surveillance takes place.  There is one major exception—no one will be able to tell that you had surgery.

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