Download Minimally invasive video- assisted thyroidectomy

Liver, Renal &
Surgery
Minimally invasive videoassisted thyroidectomy/
parathyroidectomy (MIVAT/P)
Information for patients
This leaflet explains a type of keyhole surgery called minimally invasive videoassisted thyroidectomy/parathyroidectomy (MIVAT/P), what conditions it is
used to treat, the benefits and the risks. If you have any questions, please do
not hesitate to ask one of the nurses or doctors caring for you.
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What is MIVAT/P?
It is a type of keyhole surgery that enables your surgeon to remove
part or all of your thyroid gland, one or more of your parathyroid
glands, or nodules (lumps) on these glands using a much smaller cut
than usual. With traditional ‘open’ surgery, they need to make a cut
that’s about 8 – 10cm long; with MIVAT/P, it is only 1.5cm – 2cm.
To guide them, they put a thin flexible tube called an endoscope
into the cut. This has a light source and a video camera at one end,
and it lets them see magnified (enlarged) pictures of the inside of
your body on a television screen. Your surgeon also operates using
very small surgical instruments through the same cut.
Why do I need this procedure?
We usually offer you this type of surgery to treat benign or
malignant (non-cancerous or cancerous) conditions. They include:
• overactive thyroid gland (hyperfunctioning/hyperthoidism) which
is making too much thyroid hormone and needs to be wholly or
partially removed (total or partial thyroidectomy)
• small lumps or growths (nodules) on your thyroid gland which
need to be taken out to check because they may be cancerous
• enlarged parathyroid glands which are making too much
parathryoid hormone and need to be removed.
We may not offer you this type of surgery if you:
• have had neck surgery before
• need a large thyroid gland or lumps removed
• have secondary cancer in your cervical lymph nodes (lateral
cervical lymph node metastases).
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What are the benefits?
• If you have an overactive thyroid, the surgery will stop the
symptoms.
• If you have a thyroid nodule that we think is cancerous
(malignant), we can take it out and diagnose the problem.
• If you have parathyroid disease, the operation will stop you losing
bone density, make you less tired and depressed, protect your
heart and blood vessels from more damage and prevent kidney
stones.
• The surgical cut – and so any scarring – is much smaller.
• It can reduce your risk of complications.
• You have less pain after the operation.
• You do not need to stay in hospital as long.
What are the risks?
The risks of this type of surgery are the same as the traditional
method. They include:
• Surgery does not cure your condition: your first operation might
not cure you because we can only diagnose certain conditions –
such as thyroid cancer or parathyroid disease that involves many
glands– after we have looked at the tissue we removed.
• Infection and bleeding: you have a less than 1% risk of
infection and bleeding.
• Damage to your laryngeal nerves: there is a less than 1%
risk during thyroid operations and a less than 0.5% risk during
parathyroid operations of damaging one of the nerves attached
to your voice box. It is extremely rare (fewer than one in 10,000
operations) to damage both the left and the right nerves. If this
does happen, we might need to make a hole in your windpipe
(tracheostomy) so you can breathe. In addition, because these
nerves control the movement of your vocal chords, you voice may
change if they become inflamed or damaged – it will be similar to
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what it is like when you have a bad sore throat.
• Voice changes: you have a 3% risk that your voice might be
changed by the surgery. This can happen if smaller nerves close
to your laryngeal nerve are injured. It may affect how loud you
can speak and the tone of your voice. Your voice is usually back
to normal within a year of having the operation in about 80% of
cases.
• Low calcium level: you have a 50% risk of a temporary low
level of calcium in your blood and a less than 0.3% risk of this
being permanent. It can be caused by damage to your parathyroid
glands and may lead to numbness around your mouth and pins
and needles in your fingers. To try to prevent low calcium levels,
we give you calcium tablets for two – six weeks after your surgery.
If you have any of these symptoms, please tell us straight away so
we can give you the treatment you need.
• Hormone replacement therapy: if you have your thyroid
gland totally removed you will need to have thryoxine hormone
replacement therapy for the rest of your life.
• Disease comes back: this can happen if we take out only part
of your thyroid gland; if one of your parathyroid glands starts
becoming hyperactive; or you have a benign (non-cancerous)
tumour (adenoma) that we did not find during surgery.
• Conversion to traditional surgery: we may find we need to do
open surgery instead, which means you will have a larger scar.
Are there any alternatives?
Your doctor will discuss any alternative treatments that are suitable
for you during your outpatient appointment. These may include
radioiodine therapy for an overactive thyroid gland or a ’watch and
wait‘ approach to keep an eye on benign (non-cancerous) nodules.
If you have nodules that are bigger than 25-40mm in diameter, we
will offer you traditional open surgery.
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You can opt to have one or the other technique MIVAT/P surgery or
the traditional type of surgery at any time. The investigations you
need before surgery and the care you have in hospital before, during
and afterwards are this same. But you may need another ultrasound
scan of your neck if you are havng MIVAT so the surgeon can
measure your thyroid gland better.
What are the differences between MIVAT/P and
traditional surgery?
• For MIVAT/P, you lie on your back with your head in its normal
resting position. This means you are less likely to have pain in your
neck after the operation. With traditional surgery, your neck is
fully stretched out and tilted backwards slightly (hyperextended)
so your surgeon can get better access to your thryoid or
parathyroid glands.
• Your surgeon needs to make a much smaller cut with MIVAT/P, so
your scar is smaller and less noticeable.
• Because you surgeon uses a endoscope during the MIVAT/P, they
see an enlarged (magnified) image of your glands and nerves. This
enables them to do finer surgery and makes it easier for them to
operate on very specific areas.
• MIVAT/P may be quicker and you may not need to stay in hospital
for as long.
Consent
We must by law obtain your written consent to any
operation and some other procedures beforehand. Staff will
explain all the risks and benefits and alternatives before
they ask you to sign a consent form. If you are unsure
about any aspect of the treatment proposed, please do not
hesitate to speak with a senior member of staff again.
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Valuables
Please do not bring in valuables, jewellery or large sums of money. If
this is unavoidable, please ask a relative to take them homefor you.
If this is not possible, hand in any valuables to the nurse in charge of
your ward when you arrive. They will be listed and locked in a safe
and you will be given a receipt. The hospital cannot accept liability
for the loss of items that are not handed in for safekeeping.
Where will I have the operation?
During your outpatient appointment you will be told if you will have
your operation:
• as day surgery, which means you will come to our specialist Day
Surgery Unit, have your operation and go home, all on the same
day; or
• you need to be admitted the night before surgery and stay in
hospital for at least two nights.
To have your operation as day surgery, you should:
• live no more than 30-40 minutes by car from the hospital, in case
of emergencies
• have someone who can bring you to the hospital, take you home
and stay with you for the 24-48 hours afterwards
• not have had previous operations on your neck or need extensive
surgery, because of the high risk of complications.
What happens before the operation?
Pre-assessment clinic: before having your operation, we will ask to
come to the pre-assessment clinic. This is so we can check you are
well enough to have the surgery and general anaesthesia. You will be
here for half a day. We will ask your questions about your health and
you will have some screening tests. These may include blood tests, an
electrocardiogram (ECG) and other investigations, if necessary.
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Arranging the date for your operation: after your pre-assessment,
one our admissions team will call you to agree a convenient date for
you to come in for your surgery.
Do I need to keep taking my regular medication?
We will review your medication at your outpatient appointment.
You can take most of your regular medication until the day of your
surgery. Please tell us if you are on anticoagulation (blood-thinning)
medication because you may need to stop taking this for a few days
before surgery.
At the pre-assessment appointment, we may tell you how to
manage your anticoagulation medication or prescribe you different
or more medication to prepare you for surgery. If you take blood
pressure tablets or regular medication, one of the doctor admitting
you to the hospital/day surgery will give you more information.
What happens during the operation?
You have a general anaesthetic for this procedure so you will be
asleep during your operation.The anaesthetist will put a cannula
(thin plastic tube) in your arm through which they will give you the
anaesthetic.
Once you are asleep, your surgeon will disinfect your skin and cover
your body with sterile cloth. They will make a 1-2cm cut in your
neck above the breast bone and remove your parathyroid glands, all
or some of your thyroid gland, or lumps on these glands. They may
put a small plastic tube in your neck to prevent blood clots. They will
close the cut using metal clips or a stitch inside your neck that you
cannot see. Once the operation is over you will be taken to recovery
to wake up.
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How long does the operation take?
It can take from 15 minutes to two hours.
What happens after the operation?
You will be taken to the ward and stay there for at least two – three
hours to recover. Once you feel awake and have had a drink and
something to eat, we will encourage you to get up and move
around the ward.
You will feel some mild discomfort but ordinary painkillers should
help ease any pain.
If you have your operation as day surgery, because you have had a
general anaestheric you must have someone to collect you and stay
with you for the first 24-48 hours. During the first 24 hours you
should not:
• drive or operate any motorised vehicle or electrical equipment
• sign any legal documents or make important decisions
• drink alcohol or take recreational drugs
You may feel weak or dizzy at times during the first seven – ten
days. If this happens, sit down until the feeling passes. You may also
have the ‘post-operative blues’ and feel a little depressed.
How soon will I recover?
You can go back to work when you feel fit, depending on your job.
You usually do not need more than a week off; some patients have
even gone back to work within 48 hours.
You can drive 24 hours after your surgery if your scar does not hurt
and you are able to turn your head freely. You must not drive until
this disconfort has gone.
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You can shower 72 hours after your operation, but do not scrub
your neck for at least 10 days.
Will I need to come back to hospital?
You will have an outpatient appointment five days after your
operation to remove the metal clips in your neck. You may also have
blood tests.
We will arrange another appointment for you to discuss the result of
the tests on the tissue you had removed during your surgery.
After this appointment your GP will usually check your progress.
Who can I contact with queries and concerns?
Please contact us if you have any questions before and after your
operation or need urgent medical help at any time of day or night.
Urgent calls in the 24 hours after your surgery
Mr Klaus-Martin Schulte, Consultant in Endocrine Surgery
Tel: 07780 997550
Dr Gabriele Galata, Senior Clinical Fellow
Tel: 07883 633881
For all other queries
Darshna Patel, Thyroid Clinical Nurse Specialist
Tel: 020 3299 1053 or 020 3299 3034
E-mail: [email protected]
Mr Schulte
Email: [email protected]
Dr Galata
Email: [email protected]
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If you cannot contact any of our team and you need urgent
medical help, please come to the Emergency Departmet
(ED) at King’s College Hospital.
Sharing your information
We have teamed up with Guy’s and St Thomas’ Hospitals in a
partnership known as King’s Health Partners Academic Health
Sciences Centre. We are working together to give our patients the
best possible care, so you might find we invite you for appointments
at Guy’s or St Thomas’. To make sure everyone you meet always has
the most up-to-date information about your health, we may share
information about you between the hospitals.
Care provided by students
King’s is a teaching hospital where our students get practical
experience by treating patients. Please tell your doctor or nurse
if you do not want students to be involved in your care. Your
treatment will not be affected by your decision.
PALS
The Patient Advice and Liaison Service (PALS) is a service that offers
support, information and assistance to patients, relatives and
visitors. They can also provide help and advice if you have a concern
or complaint that staff have not been able to resolve for you. The
PALS office is located on the ground floor of the Hambleden Wing,
near the main entrance on Bessemer Road - staff will be happy to
direct you.
Tel: 020 3299 3601
Fax: 020 3299 3626
Email: [email protected]
You can also contact us by using our online form at
www.kch.nhs.uk/contact/pals
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If you would like the information in this leaflet in a different
language or format, please contact PALS on 020 3299 1844.
Where can I get more information?
For Graves disease and eye problems
Thyroid eye disease association. Provides information, care and
support for those affected by thyroid eye disease including
telephone helplines throughout the UK.
For complex genetic endocrine disease
Amend. Association for Multiple Endocrine Neoplasia (MEN)
Disorders. Information and support for people with MEN type 1 or 2.
www.amend.org.uk
For thyroid cancer
British Thyroid association.
www.british-thyroid-association.org
British thyroid foundation
www.btf-thyroid.org
NICE guidelines for head and neck cancer
http://guidance.nice.org.uk/CSGHN/PublicInfo/pdf/English
Suggested reading:
Royal College of Surgeons
AK SAMY, D RIDGWAY, A ORABI, A SUPPIAH. Minimally invasive,
video-assisted thyroidectomy: first experience from the United
Kingdom. Ann R Coll Surg Engl 2010; 92: 379–384
doi 10.1308/003588410X12628812459977
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www.kch.nhs.uk PL621.1 January 2014 Corporate Comms: 0299
Review date January 2017