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Clinical Briefing: Minimally Invasive Thyroidectomy for Follicular Neoplasm

May/June 2008

Penn Head and Neck Cancer Surgery recently introduced a variety of minimally invasive techniques for thyroidectomy that substantially reduce the impact of open thyroid surgery for patients requiring diagnostic interventions for follicular neoplasms. About 80 percent of these growths are benign nodules, cysts and hyperplastic growths; the remainder are papillary or follicular carcinomas.

Unlike papillary carcinomas, follicular neoplasms of the thyroid can only be diagnosed via surgical resection. Because the majority of these nodules are benign, the advantages of minimally invasive thyroid surgery at Penn over open surgery — including reduction in incision size, minimized dissection, decreased pain and infection at the surgical site and faster recovery times — offer patients both an optimal surgical option and an important contribution to quality of life.

Case Study
Mrs. L, a 35-year-old woman, was referred to the Penn Center for Head and Neck Surgery for evaluation of an enlarged mass in the left anterior neck. At presentation, Mrs. L reported no disturbances of breathing, speech or swallowing. The mass was painless and not fixed. She was clinically euthyroid and her TSH was 2.25 mlU/L (normal = 0.35 to 5.5).

In consult with the departments of radiology and nuclear imaging, an ultrasound of Mrs. L's neck was ordered revealing a discreet nodule in the posterior left lobe of the thyroid. An ultrasound-guided fine needle aspiration of the thyroid nodule revealed indeterminate microfollicular cytologic patterns and colloid tissue suggestive of follicular neoplasm.

A minimally invasive video-assisted thyroidectomy (MIVAT) was performed to remove the nodule. After a 1.5-inch incision was made, the thyroid was dissected from the surrounding tissue and the middle thyroid vein was transected. The thyroid was retracted medially and an endoscope was used to visualize the superior and inferior poles.

Penn's team of head and neck cancer surgeons perform a minimally invasive video-assisted thyroidectomy (MIVAT)

The vessels in these regions were dissected using a suction freer, and then ligated. The two parathyroids were visualized, as was the recurrent laryngeal nerve, and were left intact. The thyroid was then dissected free from the trachea, and clamped across the midline. The incision was closed without a drain.

Mrs. L woke from surgery without any difficulties. The surgery was completed in less than two hours. A histopathologic examination of the neoplasm determined that it was a benign follicular adenoma. Mrs. L's postoperative course was unremarkable.

Our Team of Faculty
The Center for Head and Neck Cancer Surgery at Penn offers a comprehensive array of diagnostic, surgical and medical services for individuals with cancers of the head and neck. The multidisciplinary team is composed of nationally and internationally renowned specialists in the fields of otorhinolaryngology, head and neck surgery, endocrinology, radiology, cytology and pathology.

The division's goals are to integrate medical, surgical and diagnostic measures to reduce mortality and morbidity during initial therapy for advanced cancers of the head and neck and to prevent the recurrence of disease during long-term follow-up.

Otorhinolaryngology – Head and Neck Surgery
Hospital of the University of Pennsylvania

Bert O'Malley, Jr., MD
Gabriel Tucker Professor and Chair

Ara A. Chalian, MD
Associate Professor

Erica R. Thaler, MD
Associate Professor

Gregory S. Weinstein, MD, FACS
Professor and Vice Chair

Otorhinolaryngology – Head and Neck Surgery
Penn Presbyterian Medical Center

Soo Kim Abboud, MD
Clinical Assistant Professor

Natasha Mirza, MD
Associate Professor

Otorhinolaryngology – Head and Neck Surgery
Pennsylvania Hospital

James J. Kearney, MD
Clinical Assistant Professor

Jason G. Newman, MD
Assistant Professor

Endocrinology
Hospital of the University of Pennsylvania

Stephanie Fish, MD
Assistant Professor of Medicine

Kolin K. Hoff, MD
Assistant Professor of Medicine

Susan J. Mandel, MD, MPH
Associate Professor of Medicine

Endocrinology
Pennsylvania Hospital

Stephen G. Rosen, MD
Chief, Endocrinology & Metabolism

Carrie M. Burns, MD
Assistant Professor of Clinical Medicine

Maria Benito-Herrero, MD

Radiology

Jill E. Langer, MD
Associate Professor of Radiology

Susan Rowling, MD
Clinical Assistant Professor of Radiology

Access
Patient appointments are available at:

Otorhinolaryngology – Head and Neck Surgery
at Hospital of the University of Pennsylvania
3400 Spruce Street
Silverstein Pavilion, 5th Floor
Philadelphia, PA 19104

Otorhinolaryngology – Head and Neck Surgery
at Penn Presbyterian Medical Center
Medical Office Building, Suite 205
38th and Market Streets
Philadelphia, PA 19104

Otorhinolaryngology – Head and Neck Surgery
at Pennsylvania Hospital
811 Spruce Street
Philadelphia, PA 19107

Endocrinology at Hospital of the University of Pennsylvania
Endocrinology Patient Care Clinic
3400 Spruce Street
1 Maloney Building
Philadelphia, PA 19104

Endocrinology at Pennsylvania Hospital
Penn Endocrine Associates
Pine East Building, Suite B1
800 Spruce Street
Philadelphia, PA 19107

To refer a patient and/or consult with a doctor visit www.entconsult.org, call 800-789-PENN (7366) or you can also refer a patient online.

	Referring Physicians: To speak with a Penn physician or refer a patient, contact PennHealth through the secure online referral form or by calling 1-800-789-PENN (7366).