collar incision for thyroidectomy

If the voice is still hoarse after 3 to 6 months, the surgeon may prescribe voice-strengthening exercises or ask the patient to visit with a voice specialist for evaluation. The neck was entered through a collar incision, and bleeding was controlled with electrocautery. This test is used in patients with hoarseness, a previous neck operation, or cases of advanced cancer. Minimally Invasive Thyroid Surgery The typical incision made for thyroid surgery is known as a "collar incision" in which a large incision (around 5 to 6 inches) is made stretching from one side of the neck to the other just above the collar bone. A number of technological advances such as advanced energy devices for hemostasis. Acceptable wound cosmetology has . In the past, piecemeal or berry picking operations have been advocated, but currently, removal of all lymph nodes in all levels or compartments containing metastatic nodes is performed. h. Opening of the chest in the surgical management of substernal goiter is rarely required. The complications, including hypoparathyroidism, tracheal injury, esophageal injury, or surgical site infection did not occur. Incomplete removal of the thyroid and complications in preserving all the critical structures beneath and around the thyroid gland are frequent events among inexperienced and occasional thyroid surgeons. Under the premise of oncological effectiveness, endoscopic thyroidectomy can provide a safe option for these patients [5]. This helps to ensure proper wound healing in the postoperative period. Minimally invasive thyroid surgery refers to certain types of surgery in which the thyroid is removed through very small incisions using special techniques. Classically 8-12 cm (3-5 inch) incisions were performed. The cosmetic effect and the self-healing of the discomfort in the anterior neck area and SCM suggest that the application of gasless endoscopic trans-axillary thyroidectomy is feasible. Johri G, Chand G, Mishra A, Mayilvaganan S, Agarwal G, Agarwal A, et al. Meanwhile, prospective clinical studies are needed to investigate and validate surgical and oncological outcomes. HOW BIG WILL THE INCISION BE? The system also has tremor filtration and scaling of movements to eliminate tremor and allow very fine microsurgical movements if needed. However, bleeding in the neck is potentially life-threatening because as the blood pools, it can push on the windpipe or trachea causing difficulty breathing. All authors have agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. And their results showed this procedure was feasible with an acceptable safety profile where the need of conversion to conventional thyroidectomy was found in only 2 (0.45%) cases. 2021; https://doi.org/10.1007/s00464-021-08424-y. Because much of the earlier thyroid surgery was done for malignancy, descriptions emerged regarding the appropriate way to accomplish a thyroidectomy combined with a neck dissection. It is rare for them to appear after 72 hours. Chapter 42 Incisions in Thyroid and Parathyroid Surgery. The patients were either satisfied or very satisfied with the cosmetic effects. Our results revealed the complications rate was relatively low and acceptable (Table 2). 87 Xiangya Road, Changsha, 410008, China, Rong Cong,Xinying Li,Hui Ouyang,Wenbo Xue,Zeyu Zhang&Fada Xia, You can also search for this author in Statistical analyses were conducted using the Students t test and one-way ANOVA through the SPSS 23.0 software. UC Irvine was the first institution on the West Coast of the United States to perform this operation. Even in the rare chance of having a permanently hoarse voice, there are things that can be done to improve or fix the voice. WBX and ZYZ edited the manuscript. From July 2020 to March 2021, 51 patients (49 females and 2 males) underwent operations by gasless, endoscopic trans-axillary approaches, with one patient whose operation was converted to open surgery because of internal jugular vein injury. Springer Nature. Medical records were reviewed retrospectively. This suggests that discomfort in the anterior neck area and SCM is obvious shortly after surgery and is relieved over time in most cases. The midline fascia was divided and strap muscles separated from the thyroid gland. Moreno Llorente P, E AGL, Alberich Prats M, Francos Martnez JM, Garca Barrasa A. Surgical approaches to thyroid. Surg Endosc. If the mass is deep inside the chest, the surgeon makes an incision along the middle of the chest bone. The operation generally lasts from 2-3 hours. Approximately 70% of patients who have half of a normal thyroid gland left in place will not require thyroid hormone replacement pills. Modern thyroid surgery found its origins in the late 19th century in the work of Billroth and Kocher.7 Although Billroth is credited with first systematically pursuing thyroidectomy in a deliberate fashion, it was Kocher who developed a safe and reproducible technique for accomplishing a therapeutic thyroidectomy. As the scar heals, it will appear to be part of the crease and thus camouflage it. In this operation, an incision is made in the axilla (armpit) and dissection is carried superiorly across the collar bone into the neck. The two other complications that may occur after thyroid surgery involve two of the structures that are intimately associated with the thyroid gland and that may be affected by surgery, the parathyroid glands and the recurrent laryngeal nerve. In general, patients may resume taking their normal medications the day after the operation. Because these structures are intimately associated with the thyroid gland, your calcium levels may be affected either temporarily or permanently after thyroid surgery. World Journal of Surgical Oncology Kang JB, Kim EY, Park YL, Park CH, Yun JS. After a completion thyroidectomy, patients will need to take thyroid hormone replacement pills (one pill a day for the rest of their lives). The mean size of the benign tumors was 39 mm (range 3149 mm), and the mean size of malignant tumors was 10,0 mm (range 526 mm) (Table 1). In addition to using very small incisions, our surgeons "hide" the incision in a natural skin crease which acts like camouflage. If one of these nerves is injured, the voice may become hoarse. If a patient has symptoms caused by low blood calcium, the surgeon may prescribe extra calcium and a vitamin D supplement. For patients who develop hypertrophic scars, those who develop keloids and persons who want to do everything possible to avoid an incision on the neck, this procedure is possible. In general, patient should be able to eat their normal diet, but most patients prefer softer foods for the first few days. FDX conceived of the design of the study. What percentage of the human body is water? Routine level 2b dissection may be recommended only in N1b papillary thyroid carcinoma with three- or four-level lateral lymph node metastasis. B A 4-cm length incision was made in the natural wrinkle of axilla and an accessory 5-mm incision was made for another operative instrument, Three standard steps method for working space make. The length of the incision will vary depending on the thickness of the neck and the size of the gland or nodule, although it should be noted that virtually always the benign gland or nodule can be bigger than the incision itself, as these structures are compressible and can be manipulated through an incision smaller than the gland. The first lymph nodes to be involved are generally the paratracheal lymph nodes. The stiffness and paraesthesia of the SCM resulting from the division of the SCM are also relieved over time. The PSSs were 1 (very satisfied), 2 (satisfied), 3 (unsatisfied), or 4 (very unsatisfied) [13]. Most people will not be able to notice the incision once the redness fades away. 82073262) and the Hunan Province Natural Science Foundation (grant number 2019JJ40475). The paratracheal lymph nodes are divided into pretracheal, prelaryngeal, and right and left lateral paratracheal lymph nodes. Indications: Proven neoplasm (FNAC) Suspected neoplasm Age: Extreme Sex: Male Furthermore, the sensory change and paralysis results from this technique and patients satisfaction with the cosmesis were also studied. Because there is no more gland to produce thyroid hormone after a total thyroidectomy, patients are dependent on long-term thyroid hormone supplementation after surgery. Only gold members can continue reading. Liang J, Zhan L, Xuan M, Zhao Q, Chen L, Yan J, Kuang J, Tan J, Qiu W. Thyroidectomy for thyroid cancer via transareola single-site endoscopic approach: results of a case-match study with large-scale population. Lobe TE, Wright SK, Irish MS. This chapter presents historical discussions followed by a series of important guiding principles that serve as fundamental reference points during thyroid and parathyroid surgery incisional design. With this type of anesthesia, you are completely asleep during the operation, and you will have a breathing tube placed temporarily to protect your airway and lungs. There are two nerves called the recurrent laryngeal nerves that run just behind the thyroid. The best way to identify the proper crease and overall location is with the patient sitting upright in the preoperative holding area rather than waiting until the patient is lying supine on an operating table (Figure 42-6). In general, there are three types of thyroid resections: A total thyroidectomy may be done for a variety of diseases including thyroid cancer, Graves' disease (See Hyperthyroidism ), multinodular goiter, and substernal goiter, among others. https://emedicine.medscape.com/article/2051665-overview. A 5-6 cm transverse collar skin incision was made into the midline of the anterior neck 2 cm above the sternal notch. Article 2011;25:135863. Rarely, a patient may have temporary changes in the voice such as fluctuations in volume and clarity (hoarseness). The addition of robotics can improve surgical dexterity in a difficult-to-reach anatomic region [6]. Medication to normalize abnormal thyroid hormone levels may help decrease the size of goiters. The supraclavicular lateral collar incision is a feasible and safe approach for thyroidectomy. Thyroidectomy incisions have significantly decreased in size since Kocher first popularized his low collar incision in the late 19 th century 4. Huang Z, Qin H, Liao J, Meng L, Qin Y, Li B, et al. E, F Step three, the strap muscles were dissected laterally and the retractor was placed beneath the straps muscle to expose the thyroid lobe. Gasless, endoscopic trans-axillary thyroid surgery is a feasible procedure with acceptable safety and better cosmetic results in strictly selected patients. Kendall Jenner and her new love Bad Bunny were both seen arriving at the Mark Hotel in New York City on Monday ahead of their anticipated arrival at the Met Gala later in the evening. J Laparoendosc Adv Surg Tech A. . This work was supported by the National Natural Science Foundation of China (grant No. In each patient, the indication for surgery was a small nodule of unclear malignant potential. We divided the patients into two groups in surgical order to compare the VRSs regarding paralysis of the SCM. Mitchem JB, Gillanders WE. Koh YW, Park JH, Kim JW, Lee SW, Choi EC. Poor cosmetic result from scarring of the neck or axillary incision may occur and require secondary scar management. Kim EY, Lee KH, Park YL, Park CH, Lee CR, Jeong JJ, et al. Patients will receive general anesthesia. When this happens, you can trim the edges or let the glue fall off on its own. Medscape. have been classified as minimally invasive. After showering, pat the incision dry. At the Columbia Thyroid Center, 95% of our patients are able to go home after a 4 hour observation period in the recovery room. endstream endobj 33 0 obj <>>> endobj 34 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text/ImageC]/XObject<>>>/Rotate 0/Thumb 11 0 R/TrimBox[0.0 0.0 612.0 792.0]/Type/Page>> endobj 35 0 obj <>stream The contribution of the incision to the cosmetic outcome does not end with the making of the incision itself. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. Substernal Goiter Surgery. 2005;15:64752. Please see the Expert Consult website for more discussion of this topic. The time of LT with or without CND was 40.9 15.1 min (range 3090 min). Figure 42-2 This nonobese gentleman who has a 26-inch neck circumference and a large goiter would not be a candidate for any minimally invasive approach. The most recent trend has been to perform thyroid surgery while avoiding any neck incision at all. You can shower and wash your hair as usual, but do not soak or scrub the incision. In general, patients should be eating, drinking, walking around, and doing their normal activities the night of the operation. It seems no consensus has been reached on the clinical application of this technique considering the discrepant complications rate. As per the largest study done, the rate of sternotomy is less than 5%, the complication rates are acceptable, and the mortality is less than 1%. Figure 42-3 This young woman who has an 11-inch neck (A) and a solitary 2-cm nodule (B), which cytologically is consistent with a follicular neoplasm, is an excellent candidate for a minimal invasive or remote access procedure. Cir Esp (Engl Ed). They are typically not dangerous unless cancer cells develop in the goitrous thyroid enlargement. 0 It is uncommon, but when it occurs after thyroidectomy, it is usually associated with Grave's disease. Please see the Expert Consult website for more discussion of this topic, including Figure 42-1. Most patients (97%) will not notice any change in their voice after the operation. After the seventh day, reduce the calcium to one Tums Ultra 1000 tablet three times a day until your follow-up appointment. Figure 42-5 Delivery of a thyroid lobe through a minimal access incision (A), which is just big enough to admit the gland. Surg Endosc. If any of these symptoms happen, the patient should call 911 first and then their surgeon. In our study, only two cases had temporary vocal cord paralysis. During the procedure: Goiters are noncancerous enlargement of the thyroid gland. B, With wide elevation of subplatysmal flaps, all levels of the neck are accessible. Verbal response scores (VRSs) for sensory changes around the anterior chest and paralysis of the SCM (1-week, 1- and 3- month visits) were as follows: 0 = Never, 1 = Sometimes, 2 = Most of the time, 3 = All the time [14]. The 27-year . Department of General Surgery, Xiangya Hospital, Central South University, No. Goiters may be a result of the over or underproduction of the thyroid hormone or the presence of nodules in the thyroid gland. The recurrent laryngeal nerve provides nerve input to the vocal cords, and is also intimately involved with the thyroid gland. Popular incisions included the Lahey incision (Figure 42-1, A), the MacFee incision (Figure 42-1, B), and eventually a hockey stick type of incision (Figure 42-1, C).8 This last approach developed with recognition of the dangers of a trifurcated incision in which the tips of the trifurcation were prone to ischemia and devitalization, sometimes putting the great vessels of the neck at risk. XYL and HOY analyzed the data. A popular alternative to cones is a post-op surgical/recovery suit. Ryan WR. Muenscher A, Dalchow C, Kutta H, Knecht R. The endoscopic approach to the neck: a review of the literature, and overview of the various techniques. The primary advantage of this surgical procedure is avoidance of an incision on the neck. While the majority of patients accept a thyroidectomy scar, a certain percentage of patients are not satisfied with a visible scar on the neck. It provides satisfactory cosmetic outcomes compared with conventional transcervical incision. The exclusion criteria were as follows: (1) patients with benign nodules with diameters > 6 cm, (2) patients who needed a total thyroidectomy, and (3) patients for whom endoscopic surgery was not suitable due to past medical history of cervical and chest wall surgeries or other reasons. 2016;23:40238. Patients diagnosed with thyroid cancer and thyroid nodules with diameters > 4 cm who underwent trans-axillary thyroid surgery from July 2020 to March 2021 in Xiangya Hospital were retrospectively enrolled. Risks of the thyroid surgery include the risks common to all surgeries including risks associated with administration of general anesthesia, bleeding, and infection. AN INCISION (CUT) THAT WILL REQUIRE SPECIAL CARE. World J Surg Onc 20, 9 (2022). The average drainage volume was 48.0 24.4 ml (20100 ml) on day one and 13.7 5.6 ml (1030 ml) on day two. Kocher himself, however, recognized the logic behind utilizing as small an incision as possible and is quoted as saying thyroidectomy incisions should be as small as possible, as big as necessary, therefore perhaps qualifying him as the first minimally invasive surgeon. Some people experience a dull ache, while others feel a sharp pain. In conclusion, these results revealed that gasless, endoscopic trans-axillary thyroidectomy is a feasible surgery type with an acceptable safety profile and cosmetic outcomes in strictly selected patients. The surgical procedure was similar to the methods described by other surgeon groups [11, 12]. Objective: To verify the effectiveness and cosmetic results of thyroidectomy through a lateral supraclavicular incision. Skin flaps were created deep to the platysma up to the hyoid bone and down to the suprastemal notch. Kang SW, Jeong JJ, Yun JS, Sung TY, Lee SC, Lee YS, et al. All goiters are then removed. 2010;24:18897. However, depending on the presence of any visible skin crease, a higher incision at the cricoid level along the visible skin crease is sometimes preferred to enhance the cosmetic outcome (Fig. All data generated or analyzed during this study are included in this published article. Popular incisions included the Lahey incision (Figure 42-1. Kim SK, Park I, Hur N, Lee JH, Choe JH, Kim JH, et al. This can also happen after parathyroid surgery. All authors have no conflicts of interest or financial ties to disclose. Minimally invasive thyroidectomy is a surgical approach to remove the thyroid gland through smaller incisions. It is critical to work with a team of thyroid specialists to choose the right operation for each individual patient. Lang BH, Chow MP. Surg Endosc. Collar incision was made about 2 1/2cm above the inner ends of the clavicle, through the platysmal muscle. The nodes may be referred to as level 6 lymph nodes based on the AJCC staging criteria. Great efforts are made during surgery to identify and preserve this nerve on both side of the thyroid gland. The typical recommendations for pre-operative testing include: In addition, patients may require additional tests in certain situations to help plan the operation. See our Scar Gallery section for examples of minimally invasive thyroid surgery. The Procedure of Traditional Low Collar Incision Thyroidectomy The patient was placed in the supine position neck hyperextension. In the absence of contraindications, substernal goiter should be treated with early surgery rather than having it run the risk of acute airway distress, especially in younger patients. Our data indicated that sensory changes around the anterior chest are relieved over time in most cases. However, the rate of complications is higher in individuals older than 60 years of age. Hoarseness generally improves within the first 3 to 4 weeks after the operation but it may take up to 6 months. Temporary or sometimes permanent hypoparathyroidism (low blood calcium levels). The opposite lobe is not removed, and in general the remaining thyroid gland will produce enough thyroid hormone for the body. Introduction: The standard approach to thyroidectomy is a collar incision via the anterior neck, and the neck scar has always been a source of worry for patients. Terms of Use. In this study, 51 patients accepted gasless, endoscopic trans-axillary thyroid surgery with only one patient whose operation was converted to open surgery. A, B Step one, dissection of the route to the anterior neck area. There is no clear definition of what minimally invasive means, and surgical incisions as large as 6 cm. Call (212) 305-0444 for appointments. PubMed Central The total mean operative time of working space make was 44 12.8 min (range 20120 min). Most thyroid nodules are small, and performing a full collar incision is not necessary to provide needed surgical exposure to safely remove the thyroid lobe. 2017;24:R1326. All existing creases can be mapped out in order to configure an incisional line that is parallel to a regional crease. Although the numbers of identified parathyroid glands have not been calculated, we considered that the recognition and protection of the parathyroid gland would get improvement with the growing experience. COVID-19 News: Vaccine Info | In Person Visits | Virtual Visits. No internal jugular vein injury was reported [19]. The vast majority of patients do not require narcotic pain medications. Some patients experience a "crawling" sensation in the skin, muscle cramps or headaches. With the transformation of thyroid and parathyroid surgery since the late 1990s, there are now a variety of methods for accessing the thyroid and central neck. 2017;274:495500. This percent decreases in older women, patients with a personal or family history of Hashimoto's thyroiditis or hypothyroidism, and patients with a family history of autoimmune disease. However, it also leads to greater trauma [22]. Novel uses of surgical robotics in head and neck surgery. You might notice bruising around your incision or upper chest and slight swelling above the scar when you are upright. PubMedGoogle Scholar. Another variation of the minimally invasive thyroidectomy is the minimally invasive video-assisted thyroid surgery (MIVAT). Cong, R., Li, X., Ouyang, H. et al. Duncan et al. TR}Iu9!'\2q/ California Privacy Statement, %PDF-1.6 % We make every effort to eliminate the use of 4 4 gauze sponges during the operation, as the material is abrasive and behaves like sandpaper when it is placed into and retrieved from small incisions. 2016;23:694700. In addition to the complications of standard thyroid surgeries listed below, there are several complications specific to this operation. We also recommend a multivitamin for most patients. The alleviation of the discomfort in the anterior neck area and sternocleidomastoid, and the cosmetic effect of gasless endoscopic trans-axillary thyroid surgery were acceptable. After surgery, the patient will stay in the recovery room for several hours. It is often possible for your surgeon to place the incision in an existing skin crease. Standard incisions that are placed too low, spanning this indented suprasternal notch region, may appear asymmetrical and tend to be hypertrophic in their midsegment as opposed to incisions higher, in a more uniform, cylindrical region of the neck. Only two patients developed temporary vocal cord paralysis and no patients developed other severe complications. This nonobese gentleman who has a 26-inch neck circumference and a large goiter would not be a candidate for any minimally invasive approach. + )&`30^2{[b#nuwUhSr e4vMHCH qOmo.S2:uZN|/L.J. Substernal goiter can be removed through a relatively straightforward collar incision in the lower neck. Temporarily lowered calcium levels occur in approximately 15-40% of patients, and is treatable with calcium and vitamin D supplementation post-operatively. American Thyroid Association Statement on Remote-Access Thyroid Surgery. Patient concern about cosmetic appearance has led surgeons to explore performing surgery through smaller incisions to extract tumors. The parathyroid glands control calcium homeostasis within the body. &P3J&lwT,Y+noVac?GEbd1ygA( 4 Technologic A number of technological advances such as advanced energy devices for hemostasis,1 high-resolution endoscopes for improved visualization,2 and laryngeal nerve monitoring3 have increased the focus on cosmetic outcomes and the pursuit of smaller, well-camouflaged incisions.4 Also emerging are techniques for remote access thyroid and parathyroid surgery.5,6 Conventional surgery remains necessary in many circumstances, such as for large substernal goiters or advanced malignancy, and will remain in the endocrine surgeons armamentarium. The suit covers the incision and prevents your dog from licking or chewing the incision. The dissected area is marked in red. Most patients may need to take thyroid hormone pills (thyroid hormone replacement) for the rest of their lives when the whole thyroid gland is removed. hbbd``b`$M .$A "H$&X@2`b AzU R\bitiL #3=|` h Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The average blood loss was 21.0 26.8 ml (10200 ml). The total mean operative time was 141.6 34.4 min (range 95240 min, from anesthetic intubation to leaving the operating room and entering the postanesthetic care unit (PACU)). When a large thyroid lobe is delivered through small incisions, it is not uncommon to observe evidence of an ischemic or traumatized skin edge, Technological Innovations in Thyroid and Parathyroid Surgery, Approach to the Mediastinum: Transcervical, Transsternal, and Video-Assisted, Non-Neural Complications of Thyroid and Parathyroid Surgery, Surgery for Locally Advanced Thyroid Cancer: Larynx, Principles in Surgical Management of Primary Hyperparathyroidism, Surgery of the Thyroid and Parathyroid Glands Expert Consult Pre. Privacy PubMed UC Irvine Department of Head & Neck Surgery, 101 The City Drive South Pavilion II Orange, CA 92868, UCI Head & Neck UCI - Audiology Department, UC Irvine Health 101 The City Drive South, Orange, CA 92868, Petrous Apex Lesions, Cholesterol Granuloma, Cyst, Cholesteatoma, Radiosurgery (CyberKnife for Skull Base Tumors or Acoustic Neuromas), Acoustic Neuroma Orange County Los Angeles Southern California, Congenital Atresia of the Ear (Non-Development of the Ear Canal), Minimally Invasive Endoscopic Skull Base Surgery, Otosclerosis Orange County, Los Angeles, Southern California, Surgical Treatment of the Tongue and Lower Throat, Independent Medical Evaluation / Workers Compensation. it is possible to perform an open thyroidectomy with an incision of 3.3-4.2cm. Ann Surg Treat Res. This chapter contains additional online-only content, available on expertconsult.com. 2 ). Excellent long-term cosmetic outcomes can be expected with minimally invasive endoscopic thyroid surgery (B). Trans-axillary robotically assisted approaches were first reported by Lobe et al. CAT scan of the chest: This test allows the surgeon to evaluate if the thyroid disease is growing down into the chest and if so, how it is affecting the structures in the chest. In the past decade, efforts were made to reduce incision size and surgical access trauma by the use of endoscopic techniques. The primary endpoint was the cosmesis of the collar scar six weeks after surgery assessed using the patient and observer scar assessment scale (POSAS). Patients should discuss with their doctors when and if they should restart these medications. Endoscopic hemithyroidectomy with prophylactic ipsilateral central neck dissection via an unilateral axillo-breast approach without gas insufflation for unilateral micropapillary thyroid carcinoma: preliminary report. wnya@Q7-$Omag[>JI[Kf;-TpOZ0v{ }b/n:WwWi4(^{=]~(O l4!|lgp$uWx)>lvK@#\K!i' y~F-yv~`=0%->s:K,z3/=K[po>@nrLo j, This test is used in patients with large goiters, substernal goiters, and cases of advanced cancer. These nerve control the vocal cords. During the 1850s, operations on the thyroid gland were undertaken via longitudinal, oblique, or vertical neck incisions. Because the thyroid gland is situated directly in front of the trachea, or windpipe, airway obstruction may occur if blood collects in the area after surgery. A portion of the enlarged thyroid (if possible) or the entire thyroid gland may need to be removed. The optimal position in which to mark the anticipated thyroid incision is with the patient seated upright in the holding area. 2009;56:3619. . Symptoms of hypocalcemia can generally be prevented by taking two Tums Ultra 1000 tablets three times a day for seven days after surgery along with 2000 IU Vitamin D3 daily. 2012;42:83541. Incision: A transverse collar incision is usually made 1-2 fingerbreaths above the sternum along the skin crease. C and D, Both the right and the left neck may be thoroughly dissected with appropriate retraction assistance. 2020;34:1891903. Examples of the so-called necklace neck incision associated with a classical thyroidectomy through an open approach (, Delivery of a thyroid lobe through a minimal access incision.

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