Modalities of thyroid surgery

Thyroid surgery can be performed using several different modalities, depending on the underlying condition, the extent of the disease, and patient-specific factors. The primary modalities of thyroid surgery include:

1. Total Thyroidectomy: This procedure involves the complete removal of the thyroid gland. It is commonly performed for patients with thyroid cancer, multinodular goiter, or Graves’ disease when medical management is inadequate.

2. Subtotal (Partial) Thyroidectomy: Only a portion of the thyroid gland is removed, typically one lobe and the isthmus. This is often performed for benign conditions like unilateral nodules or small goiters.

3. Hemithyroidectomy (Lobectomy): Removal of one lobe of the thyroid gland. It is usually performed for isolated thyroid nodules, unilateral thyroid disease, or indeterminate nodules where malignancy is not confirmed.

4. Isthmusectomy: This procedure involves the removal of only the thyroid isthmus, which is the thin band of tissue connecting the two lobes of the thyroid. It’s generally performed for small, isolated nodules or cancer located in the isthmus.

5. Minimally Invasive Video-Assisted Thyroidectomy (MIVAT): A minimally invasive technique using small incisions and a camera for visualization. This approach is typically reserved for small nodules or small, well-contained thyroid cancers.

6. Robotic Thyroidectomy: An advanced technique that uses robotic arms to perform the surgery. This can be done through a transaxillary (through the armpit) or retroauricular (behind the ear) approach, which avoids a neck scar. It is generally used for cosmetic purposes in select patients.

7. Transoral Endoscopic Thyroidectomy Vestibular Approach (TOETVA): A newer, scarless technique that involves removing the thyroid gland through the mouth. This method is becoming more popular for patients who want to avoid a visible neck scar.

8. Reoperative Thyroid Surgery: Surgery performed on patients who have had a previous thyroid surgery. This can be challenging due to scar tissue and altered anatomy and is often used in cases of recurrent or persistent thyroid disease, such as cancer recurrence.

The choice of surgical modality depends on various factors, including the type and extent of thyroid disease, the patient’s anatomy, cosmetic concerns, and the surgeon’s expertise.

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