Scarless thyroid surgery

Surgeons at Royal Berkshire NHS Foundation Trust recently performed the first scarless thyroid procedure in the UK. Consultant ENT surgeons, Mr Ram Moorthy and Mr Sid Nagala, had previously used the same pioneering technology to perform the UK’s first scarless parathyroid procedure in November 2022.

We recently asked Mr Moorthy about the procedure and how thyroid patients may benefit from it in the future:

What does the procedure involve?

This is the first remote-access thyroid procedure that is truly scarless. We make three small incisions on the inner aspect of the lower lip (oral vestibule). The procedure utilises a small camera (endoscope) and two instruments to safely remove the thyroid. Patients will have a dressing applied, similar to that used after a facelift or neck lift procedure.

At present patients stay in hospital overnight. As our experience with this procedure increases, we hope that it will be offered as day surgery in the future, as done in the USA. Recovery remains approximately two weeks.

What benefits does transoral surgery offer over conventional thyroid surgery?

The main benefit compared to a traditional open thyroidectomy is that there is no visible scar on the neck. The other risks are exactly the same between scarless and open thyroidectomy. Recovery is also the same. Once over the initial learning curve, the procedure takes approximately the same time to perform. 

Which patients might it be suitable for?

This procedure could potentially be offered to patients with small thyroid cancers, thyroid nodules and hyperparathyroidism in the future.

We are currently working on the following inclusion and exclusion criteria, which are based on international consensus:

Inclusion criteria

• Slim and long neck
• Thyroid is above clavicle with neck extended
• nodule <4cm in size- Normal remaining thyroid. Thyroid lobe <6cm in total.
• Hemithyroid only for first 10-15 cases
• Cytology- Thy 1,2, 3a or 3f
• For parathyroids- inferior gland with clear plane on USS between lower pole of thyroid and parathyroid gland
• ASA* Grade I or II
• Good dental hygiene

*American Society of Anaesthesiologists Physical Status Classification System: ASA grade 1 - A normal healthy patient, (that is, without any clinically important comorbidity and without a clinically significant past/present medical history), ASA grade 2 - A patient with mild systemic disease.

Exclusion criteria

• History of head and neck surgery
• History of head/neck/upper mediastinal irradiation
• Patient unfit for general anaesthesia
• Evidence of active clinical hyperthyroidism
• Preoperative recurrent laryngeal nerve palsy
• Lymph node metastasis, extrathyroidal extension including tracheal or oesophageal invasion
• Oral abscesses
• Substernal thyroidal extension **

** When the thyroid gland or masses in the thyroid grow down into the chest

When might it become more widely available on the NHS?

We have some other units that are interested in setting up a service and we would strongly encourage and support them. We are collecting data on patients’ experience and outcomes to support the wider roll-out of the procedure

Read more about the procedure

Photo credit: Royal Berkshire NHS Foundation Trust