Recurrent Laryngeal Nerve Monitoring
Perhaps the most frightening aspect of thyroid surgery is risk of injury to the recurrent laryngeal nerve resulting in vocal cord paralysis. Although there is no substitute for surgical experience and understanding of the anatomy to minimize surgical risk to the recurrent laryngeal nerve, intra-operative nerve monitoring is very useful. A special device is used to monitor the recurrent laryngeal nerve, much like a car alarm. When the nerve is stimulated the "alarm rings" signaling the surgeon, thus reducing the chance of injury to the recurrent laryngeal nerve. All thyroid surgery at the Institute is performed with recurrent laryngeal nerve monitoring in place.
Minimally Invasive Endoscopic Thyroidectomy
Standard thyroid surgery is performed through a 6-10 cm incision and requires a significant amount of dissection and trauma to tissues not directly related to the thyroid gland. This results in longer recovery and longer scars. Through the use of high definition video equipment and a small surgical telescope, thyroid surgery can be performed through a 2-3cm incision with less dissection, resulting in shorter recovery and virtually no visible scars.
The harmonic scalpel is a novel surgical instrument which utilizes harmonic frequency to dissect tissue. Its unique design allows for less thermal injury and facilitates the minimally invasive approaches to the thyroid gland.
Combined Thyroidectomy and Cosmetic Facial and Neck Rejuvenation
Patients with benign tumors may be candidates for facial and neck rejuvenation procedures in combination with their thyroid surgery. Often after thyroid surgery, the skin of the neck becomes lax. This laxity may be more pronounced in aging women and men, or in patients with larger tumors. To improve overall harmony to the neck and face, it may be beneficial for some patients to combine other rejuvenation procedures with their primary surgery. Dr. Hamilton has dual training in head and neck surgery as well as plastic and reconstructive surgery, making it possible, when appropriate, to restore form and function while simultaneously improving appearance.
Unfortunately, some thyroid tumors re-grow after initial treatment, therefore requiring further surgery. Repeat surgery increases both the chances of vocal cord paralysis and hypocalcemia. We specialize in removing recurrent tumors while maintaining vocal cord function and calcium regulation.
Functional Neck Dissection
At times there is the need for removal of certain lymph nodes from the neck in the management of thyroid cancer. This is referred to as a neck dissection. The “radical” neck dissection is the classic procedure which removes muscle, nerves, lymph nodes, and large vessels. Contemporary management utilizes the “functional” neck dissection, which only removes the lymph nodes in question. The other normal structures are not removed.
Some patients have had their thyroid surgery done elsewhere and have a persistent hoarseness due to vocal cord weakness or paralysis. Using injectable implants, often their voice quality and strength can be restored or improved. This is performed on an outpatient basis and is painless.
The Wound Care Program
The thyroid surgery will last hours but surgical scars can last a lifetime. Optimal results are obtained when preventative techniques and science are utilized. Dr. Hamilton has designed a comprehensive wound care program from start to finish, which allows each patient the opportunity to heal free of noticeable scars. If scarring is a concern of yours, this program is for you.