WHERE WILL MY THYROID INCISION BE PLACED?
Thyroidectomy incisions have traditionally been placed using a long curved incision at the base of the neck, either just above or below the collar bone (the Kocher or collar incision). This approach is still used by most surgeons as it is traditionally what was taught, but there are now alternative approaches The base of neck approach still requires a longer incision than alternatives as more dissection is required to reach the thyroid which is actually quite high in the neck. That part of the neck is also more prone to keloid (thickened scars) and is the most noticed part of the neck . Alternatives include the extracervical approaches where the incision is not in the neck at all, the mini-incision cervical approaches for small thyroid nodules, and the high cricoid approach for larger nodules and goitres.
These avoid any scar in the neck at all with incisions placed either in the armpit, the breast, behind the ear. However all these approaches require robot assistance with disadvantages and cost, just to avoid a neck scar.
These utilize a 2-3 cm incision either placed in the notch above the breast bone or in a skin crease on the side of the neck (lateral approach).. The first approach requires the assistance of an endoscope whereas the lateral approach, which was first described in Sydney 15 years ago, uses new technology which permits direct visualization. The advantages are a small incision which heals well and is less obvious than the traditional incision. However these approaches are only suitable for smaller thyroid nodules.
High cricoid approaches:
This technique, first described in New York 10 years ago (“the New York Cut”) uses a central incision high in the neck over the cricoid cartilage (the bump below where the Adam’s apple is). It is used for larger nodules as well as goitres and thyroid cancers. The advantages are that it requires a shorter incision than the traditional approach as it is placed directly over the centre of the thyroid gland. It usually heals very well and often disappears completely as it is placed in a skin crease which hides the scar. This is also the least noticed part of the neck. Keloid is exceedingly rare as scar thickening characteristically is worst on the chest wall or adjacent. There is also less pain after surgery as that area is effectively blocked during surgery with a cervical plexus local anaesthetic block.
DISCUSS INCISION SITING WITH YOUR SURGEON BEFOREHAND