Retro-Auricular Thyroidectomy: An Open Approach

Abstract

Distant access robot-assisted thyroidectomy has gained popularity in recent years. Adoption of distant access procedures has been limited by cost, need for specialized training and expertise. We report our preliminary clinical experience with our modification of the retro-auricular thyroidectomy approach that allows adequate exposure for thyroid lobectomy without robotic or endoscopic assistance. This is a retrospective chart review of ten patients who have undergone retro-auricular thyroidectomies in the absence of robotic or endoscopic assistance. Ten patients were identified to have undergone this procedure over an 18-month period. All patients were female with average age 36 years (range 27-52). Six were right sided and 4 were left sided procedures. The average gland size was 4.2 cm (range 3.7-6 cm). The average nodule size was 2.1 cm (range 1.1-3.5 cm). The average operative time was 91 min (range 76-114 min). All patients had benign pathology on final histopathology. There were no conversions to open cervical thyroidectomy. Two patients had vocal cord paresis that resolved spontaneously. The average postoperative follow up was 3 months (range 1-7 months). Our technique for retro-auricular thyroidectomy is a safe, reproducible, and cost effective option for remote access thyroidectomy.

Keywords: Distant access thyroidectomy; Retro-auricular thyroidectomy; Thyroidectomy.

Fig. 1

Retroauricular incision with 1–1.5 cm extension into a postero-lateral neck crease (dotted line marks hairline)

Fig. 2

Sub-platysmal flap raised over the sternocleidomastoid muscle. Asterisk shows the great auricular nerve

Fig. 3

Anterior border of the sternocleidomastoid delineated and retracted. During this step, the external jugular vein may need to be divided

Fig. 4

The superior pole vessels are released with harmonic focus device and the pole is retracted; dissection of the thyroid gland is continued laterally and inferiorly using standard open dissection techniques

Fig. 5

Surgical view after removal of the hemi-thyroid showing the recurrent laryngeal nerve along its course in the tracheoesophageal groove

Fig. 6

Retro-auricular incision; early and late post operative views