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Thiagarajan S, Menon A, Panmand H, Bamane P, Pawar A. A prospective study to assess cervical scar satisfaction following conventional open thyroidectomy for thyroid cancer. Eur Arch Otorhinolaryngol 2024:10.1007/s00405-024-08668-z. [PMID: 38676715 DOI: 10.1007/s00405-024-08668-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Accepted: 04/08/2024] [Indexed: 04/29/2024]
Abstract
BACKGROUND Conventional open thyroidectomy (COT) remains a common method of thyroidectomy in many parts of the world for various reasons. METHODS In this prospective (cross-sectional) study, we evaluated the scar satisfaction among patients and surgeons following COT using the Patient and Observer Scar Assessment Scale (POSAS) and the Patient Scar Assessment Questionnaire (PSAQ). RESULTS A total of 116 patients were included. The median age of the patients was 44 years and the majority were women. The median scar length overall was 12.2 cm. On POSAS, the median score for surgeon 1 was 1 (range 1-5), for surgeon 2, it was 2 (range 1-6), and for the patient, it was 1 (range 1-6) suggesting good scar satisfaction. The patient's response in the PSAQ was also echoing similar outcomes with scar satisfaction. CONCLUSIONS Overall, both the patients and the surgeons seem to be satisfied with the overall scar appearance following COT despite the scar length.
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Affiliation(s)
- Shivakumar Thiagarajan
- Division of Head & Neck, Department of Surgical Oncology, Homi Bhabha National Institute (HBNI), Tata Memorial Centre, Mumbai, India.
| | - Abhishek Menon
- Division of Head & Neck, Department of Surgical Oncology, Homi Bhabha National Institute (HBNI), Tata Memorial Centre, Mumbai, India
| | - Hrutika Panmand
- Department of Clinical Research, Homi Bhabha National Institute (HBNI), Tata Memorial Centre, Mumbai, India
| | - Pooja Bamane
- Department of Clinical Research, Homi Bhabha National Institute (HBNI), Tata Memorial Centre, Mumbai, India
| | - Akash Pawar
- Clinical Research Secretariate, Homi Bhabha National Institute (HBNI), Tata Memorial Centre, Mumbai, India
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Agne GR, Kohler HF, Lira RB, Belli M, Bento GN, Viana A, Kowalski LP. Aesthetic Perceptions Regarding a Thyroidectomy Scar and Transvestibular Approach in Brazil. Laryngoscope 2024. [PMID: 38411345 DOI: 10.1002/lary.31372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 02/05/2024] [Accepted: 02/15/2024] [Indexed: 02/28/2024]
Abstract
OBJECTIVE We investigated motivation levels across the general Brazilian population and subgroups and their willingness to spend for surgery without a cervical scar. METHODS This random-sample survey was performed by a specialized third-party research institute. In this study, we created a hypothetical thyroidectomy scenario, and the transcervical and transoral endoscopic thyroidectomy vestibular approach (TOETVA) were used. The survey included sociocultural data and questions regarding participants' surgical preferences. RESULTS Data were obtained from 1250 participants; 42.4% were of the opinion that a cervical scar affects social or professional life. Young and childless women were most likely to be affected (p <0.001). All respondents accepted the transoral approach to avoid cervical scarring. However, 30.7% and 31.9% of respondents maintained their preference for TOETVA despite understanding the risks of a hypothetical increase in complications and unfavorable oncological outcomes and 98.6% were of the opinion that this approach was likely associated with greater postoperative pain. Only 16.2% were unwilling to spend for TOETVA. The variable that most affected patients' willingness to spend was a salary greater than 10 Brazilian minimum wages (odds ratio 9.797, 95% confidence interval, p <0.005). Upper class respondents were 10 times more likely to spend for TOETVA than lower class patients. CONCLUSION This study highlights patients' interest in TOETVA. Cervical scar perception is affected by concerned about appearance, particularly in certain societal subgroups. Our study population showed significant motivation to undergo TOETVA, which was emphasized by their acceptance of the complication rate, poor postoperative outcomes, greater postoperative pain, and willingness to spend on surgery with an invisible scar. LEVEL OF EVIDENCE 4 Laryngoscope, 2024.
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Affiliation(s)
| | - Hugo Fontan Kohler
- Department of Head and Neck Surgery and Otorhinolaryngology, A.C. Camargo Cancer Center, São Paulo, Brazil
| | - Renan Bezerra Lira
- Department of Head and Neck Surgery and Otorhinolaryngology, A.C. Camargo Cancer Center, São Paulo, Brazil
| | - Marcelo Belli
- Department of Head and Neck Surgery, PESCOP Group, Balneário Camboriú, Brazil
| | - Gustavo Nunes Bento
- Department of Head and Neck Surgery, PESCOP Group, Balneário Camboriú, Brazil
| | - Acklei Viana
- Department of Head and Neck Surgery, NICAP Group, Florianópolis, Brazil
| | - Luiz Paulo Kowalski
- Department of Head and Neck Surgery and Otorhinolaryngology, A.C. Camargo Cancer Center, São Paulo, Brazil
- Department of Head and Neck Surgery, Universidade de São Paulo, São Paulo, Brazil
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Bach K, Prince S, Pitt SC, Robbins S, Connor NP, Macdonald C, Sippel RS, Long KL. Time Heals Most Wounds - Perceptions of Thyroidectomy Scars in Patients With Thyroid Cancer. J Surg Res 2022; 270:437-443. [PMID: 34798426 PMCID: PMC8712385 DOI: 10.1016/j.jss.2021.09.041] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 08/23/2021] [Accepted: 09/23/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Patients understandably have concerns about thyroidectomy scars. This study aimed to characterize patients' perceptions of their thyroidectomy scar before and up to 1-y after surgery. METHODS Patients with papillary thyroid cancer (n = 83) completed semi-structured interviews before and at 2-wks, 6-Wk, 6-mo, and 1-y post-thyroidectomy. Interviews probed about scar concerns and appearance. Content analysis was used to identify themes. RESULTS The majority of participants did not express concerns about scar appearance. When expressed, preoperative concerns often stemmed from previous surgery experiences or unease with neck incisions. Postoperatively, concerns about scar appearance decreased over time throughout the healing period with most patients being satisfied with their scar appearance by 6-mo after surgery. CONCLUSIONS Patients with papillary thyroid cancer express few concerns about scar thyroidectomy appearance. Surgeons can reassure patients who have preoperative concerns that most patients are satisfied with their scar appearance by 6-mo after surgery.
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Affiliation(s)
- Kathy Bach
- Division of Endocrine Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Madison Wisconsin USA, 53792
| | - Samantha Prince
- Division of Endocrine Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Madison Wisconsin USA, 53792
| | - Susan C. Pitt
- Division of Endocrine Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Madison Wisconsin USA, 53792
| | - Sarah Robbins
- Division of Endocrine Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Madison Wisconsin USA, 53792
| | - Nadine P. Connor
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Madison Wisconsin USA, 53792
| | - Cameron Macdonald
- Qualitative Health Research Consultants,111 King St #23, Madison Wisconsin USA 53703
| | - Rebecca S. Sippel
- Division of Endocrine Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Madison Wisconsin USA, 53792
| | - Kristin L. Long
- Division of Endocrine Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Madison Wisconsin USA, 53792
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Sahm M, Otto R, Pross M, Mantke R. Minimally invasive video-assisted thyroidectomy: a critical analysis of long-term cosmetic results using a validated tool. Ann R Coll Surg Engl 2019; 101:180-185. [PMID: 30322290 PMCID: PMC6400915 DOI: 10.1308/rcsann.2018.0178] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/10/2018] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Since its first publication in 1997, minimally invasive video-assisted thyroidectomy (MIVAT) has developed into the predominant minimally invasive surgery of the thyroid. A major advantage over conventional thyroid surgery is the superior cosmetic result. However, there are still few data comparing the long-term cosmetic results of the two methods. This paper compares the long-term cosmetic results of the two methods, based on follow-up assessments. METHODS Between 2004 and 2011, 143 preselected patients underwent a MIVAT in our department. Additionally, 134 patients underwent a conventional thyroidectomy in our hospital in 2011. A total of 117 patients from the MIVAT group and 102 patients from the conventional thyroidectomy group received follow-up assessments after 23.1 and 23.6 months, respectively, using the patient and observer scar assessment scale. RESULTS The measurable cervical scar length averaged 1.9 cm in the MIVAT group and 3.9 cm in the conventional group (P < 0.001). Some 11.1% of the patients in the MIVAT group and 7.1% of the patients in the conventional group had developed keloid (P = 0.391). The patient scar assessment score was 10.4 for the MIVAT group compared with 9.9 for the conventional thyroidectomy group (P = 0.691) and the observer scare assessment score was 8.6 for MIVAT compared with 9.9 for conventional thyroidectomy (P = 0.011). CONCLUSION In the patient assessment instrument, conventional thyroidectomy had a small advantage over MIVAT in the cosmetic long-term results. This difference between the two groups was, however, not significant. Our result contradicts short-term cosmetic results of published randomized studies with improvement for MIVAT. The Observer Score demonstrates a significant advantage of the MIVAT.
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Affiliation(s)
- M Sahm
- Brandenburg Medical School, Department of Surgery, University Hospital, Brandenburg/Havel, Brandenburg, Germany
| | - R Otto
- Institute for Quality Control in Operative Medicine, Otto-von-Guericke-University, Magdeburg, Germany
| | - M Pross
- Department of Surgery, DRK Kliniken Berlin Köpenick, Berlin, Germany
| | - R Mantke
- Brandenburg Medical School, Department of Surgery, University Hospital, Brandenburg/Havel, Brandenburg, Germany
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Makay Ö, Erol V, İçöz G, Öztürk Ş, Akdemir Ö, Akyıldız M. Kozmetik yönüyle minimal invaziv paratiroidektomi: Minimal invaziv yaklaşım daha mı üstün? EGE TIP DERGISI 2018. [DOI: 10.19161/etd.415654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Scar satisfaction and body image in thyroidectomy patients: prospective study in a tertiary referral centre. The Journal of Laryngology & Otology 2017; 132:60-67. [DOI: 10.1017/s0022215117002158] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractBackground:This study is the first to evaluate scar satisfaction and body image in thyroidectomy patients using validated assessment tools.Methods:A total of 123 thyroidectomy patients were recruited over 8 months. Both patients and clinicians completed assessment tools that included: the Manchester Scar Scale (to measure scar perception), Dysmorphic Concern Questionnaire (to assess body image), Body Dysmorphic Concern Questionnaire (to screen for body dysmorphic disorder) and EQ-5D (to measure life quality). A separate image panel comprising experts and non-experts assessed 15 scar photographs. The results were analysed using non-parametric descriptive statistics.Results:Poor body image was associated with poor scar perception (ρ = 0.178,p= 0.05). Poor life quality correlated with poor scar perception (ρ = −0.292,p= 0.001). Scar length did not affect scar perception. Prevalence of body dysmorphic disorder among patients was found to be 8.94 per cent, which is higher than general population rates.Conclusion:Negative body image and life quality impact negatively upon scar perception.
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Dordea M, Aspinall SR. Short and long-term cosmesis of cervical thyroidectomy scars. Ann R Coll Surg Engl 2016; 98:11-7. [PMID: 26688393 PMCID: PMC5234393 DOI: 10.1308/rcsann.2016.0022] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/05/2015] [Indexed: 12/14/2022] Open
Abstract
Introduction Multiple surgical approaches to the thyroid gland have been described via cervical or extracervical routes. Improved cosmesis, patient satisfaction, reduced pain (procedure dependent) and early discharge have all been reported for minimally invasive approaches with similar safety profiles and long-term outcomes to conventional surgery. This review summarises the current evidence base for improved cosmesis with minimally invasive cervical approaches to the thyroid gland compared with conventional surgery. Methods A systematic review was undertaken. The MEDLINE(®), Embase™ and Cochrane databases were searched for relevant articles. Results A total of 57 papers thyroid papers were identified. Of those, 20 reported some form of cosmetic outcome assessment. There were 6 randomised controlled trials with 412 patients (evidence level 2B), 7 cohort studies with 3,073 patients (level 3B) and 7 non-comparative case series with 1,575 patients (level 4). There was significant heterogeneity between studies in terms of wound closure technique, timing of scar assessment and scar assessment scales (validated and non-validated). Most studies performed early scar assessments, some using non-validated scar assessment tools. Conclusions Assessment of cosmesis is complex and requires rigorous methodology. Evidence from healing/remodelling studies suggests scar maturation is a long-term process. This calls into question the value of early scar assessment. Current evidence does not support minimally invasive surgical approaches to the thyroid gland if improved long-term cosmesis is the goal.
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Affiliation(s)
- M Dordea
- Northumbria Healthcare NHS Foundation Trust , UK
| | - S R Aspinall
- Northumbria Healthcare NHS Foundation Trust , UK
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Wound complications and clinical results of electrocautery versus a scalpel to create a cutaneous flap in thyroidectomy: A prospective randomized trial. Surg Today 2011; 41:1041-8. [DOI: 10.1007/s00595-010-4435-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2010] [Accepted: 05/10/2010] [Indexed: 10/18/2022]
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Long-term cosmetic results after minimally invasive video-assisted thyroidectomy. Surg Endosc 2011; 25:3202-8. [DOI: 10.1007/s00464-011-1693-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2010] [Accepted: 03/21/2011] [Indexed: 11/26/2022]
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Bärlehner E, Benhidjeb T. Cervical scarless endoscopic thyroidectomy: Axillo-bilateral-breast approach (ABBA). Surg Endosc 2007; 22:154-7. [PMID: 17440778 DOI: 10.1007/s00464-007-9393-7] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2007] [Revised: 01/03/2007] [Accepted: 01/26/2007] [Indexed: 10/23/2022]
Abstract
BACKGROUND Neck surgery is one of the latest applications of minimally invasive surgery. We applied a new technique for totally endoscopic thyroidectomy, the axillo-bilateral-breast approach (ABBA). This approach does not leave a scar on the neck. METHODS Between February 2005 and October 2005, 13 patients were treated by ABBA for uni- or multinodular goitres. Surgery is performed under general anaesthesia and in supine position. 5 mm bilateral skin incisions are made on the margin of the areola of nipple. They are used to insert and subcutaneously push forward a 20 cm long, 5 mm trocar to the jugular fossa. A further 5 mm incision is performed in the right axilla. The right breast trocar is the optical trocar. A Maryland clamp in axillary position and 5 mm harmonic scalpel via the left breast trocar permit a clear view of the further subfascial preparation. The caudal hyoidal muscles are longitudinally split along the linea alba. Using delicate blunt dissection, both thyroid lobes are exposed. After isthmus transection is performed, the upper thyroid pole is being mobilized. The upper pole vessels are isolated and divided close to the thyroid capsule. Preparation of the retrothyroidal area includes visualization of the recurrent laryngeal nerve. The resection is performed without bleeding with a harmonic scalpel. Via the axillary approach, with the incision being widened, a 20 mm trocar is inserted and advanced up to the thyroid lodge to remove the specimen. RESULTS The average operation time was 132 minutes. No patient had to be converted to a conventional approach. Hypocalcaemia or recurrent laryngeal nerve palsy were not observed postoperatively. CONCLUSION Our preliminary results show that the ABBA technique is a feasible, safe procedure with excellent cosmetic benefits. The small scars in the right axilla and bilateral nipple areola are almost invisible.
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Affiliation(s)
- Eckhard Bärlehner
- Department of Surgery and Centre of Minimally Invasive Surgery, HELIOS Klinikum Berlin-Buch, Hobrechtsfelder Chaussee 100, D-13125, Berlin, Germany
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