BY PAM MCGRATH

The thyroid gland’s function can be affected by a number of conditions. For example, Graves’ disease can trigger an overproduction of thyroid hormones; Hashimoto’s thyroiditis causes the body’s immune system to attack the thyroid gland. Growths in the thyroid, called nodules, can develop, a small fraction of which are cancerous. Dysfunction of the parathyroid glands also can produce too much thyroid hormone, resulting in high levels of calcium that increase the risk of stroke, heart attack, and osteoporosis. Many of these conditions can be treated with surgery.

Traditional surgery to treat benign or cancerous thyroid conditions requires an approximate two-inch incision on the lower part of the front of the neck. Although a low-risk surgery with few complications and a relatively short recovery time, the procedure does result in a visible scar.

“Patients often express a lack of concern about a scar when we talk about the results of a planned thyroid surgery,” says R. Alex Harbison, MD, MS, WashU Medicine otolaryngologist at Barnes-Jewish Hospital. “But after surgery, many do express some concern about the resulting scar, regardless of its size.” He notes that, according to a study published in the journal Surgery, up to 75% of patients undergoing a partial or complete thyroidectomy—removal of part or all of the gland—are self-conscious about their scar, even years after surgery. “Fortunately, we now offer an endoscopic technique that eliminates visible scarring and is available to some of our patients.”

This approach, called transoral endoscopic thyroidectomy vestibular surgery, or TOETVA, involves making three small incisions inside the mouth between the gum and lower lip. These incisions, or ports, allow the surgeon to access the thyroid without creating an incision at the front of the neck. Dr. Harbison was the first surgeon at Barnes-Jewish Hospital to perform the procedure, which was developed about 10 years ago overseas and is now becoming a more frequent option in the U.S. According to Dr. Harbison, Barnes-Jewish Hospital is one of only two hospitals in the Midwest currently offering the procedure.

“A significant advantage to this procedure is that it allows the surgeon a clear view of the critical structures located near the thyroid,” says Dr. Harbison. “During thyroid surgery, care needs to be taken to protect the nerves that control movement of the vocal cords and regulate breathing and speech, as well as the parathyroid glands that regulate calcium levels in the blood.”

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Dr. Harbison notes that there is a 1% risk of chin numbness after transoral endoscopic thyroidectomy vestibular surgery. “However,” he says, “we’re working to reduce that risk by refining the technique and further protecting the nerve that controls sensations in the chin.” In some instances, Dr. Harbison adds, excessive bleeding during scarless surgery may require the surgeon to resort to the traditional, frontal neck procedure.

According to a study published by the National Institutes of Health (NIH), outcomes for the scarless procedure are consistently as good as those offered by traditional surgery. People who undergo the scarless procedure often experience short hospital stays, rapid healing, and low complication rates.

Dr. Harbison and colleagues perform hundreds of thyroid-related surgeries every year, following specific guidelines to determine the best treatment plan for every person they treat. As Dr. Harbison and other WashU Medicine specialists at Barnes-Jewish Hospital continue to refine the scarless technique, the number of people who qualify for it is likely to increase. “We work to improve surgical techniques so we can offer the best possible care to our patients,” Dr. Harbison says.