New thyroid surgery spares patients from neck scar

Dr Jeremy Ng, head and senior consultant, Department of General Surgery of SGH and a female patient on a scar-free thyroid procedure.
Dr Jeremy Ng, head and senior consultant, Department of General Surgery of SGH and a female patient on a scar-free thyroid procedure.ST PHOTO: CHEW SENG KIM

SINGAPORE - When Ms Michelle Mak discovered she had a thyroid lump in her neck in 2015, she was hesitant to undergo surgery to remove it as conventional procedure would likely leave a 6cm scar across her neck.

But when offered a chance to remove the lump through a scar-free surgery in December that year, she decided to take it up.

"I decided to take the lump out because otherwise I would have to live with it for the rest of my life," said Ms Mak, who works in the banking industry.

In January last year, she underwent the knife to remove the lump, which had grown to 4cm by then.

To date, she is one of more than 20 patients who have since undergone the scar-free surgery at the Singapore General Hospital, since it was introduced in late 2015.

Thyroid lumps affect about 7 per cent of the population. Women are four times more likely than men to be affected.

While most lumps are benign and do not affect everyday life, some lumps grow into a visible bulge in the neck and can cause shortness of breath or difficulty swallowing. About one in 10 discovered lumps are cancerous.

As a significant number of young women are diagnosed with thyroid lumps, patients are often anxious about scarring after surgery, said Dr Jeremy Ng, head and senior consultant from Department of General Surgery at SGH.

But this scar-free procedure, known as transoral endoscopic thyroidectomy, has the smallest areas of dissection and is the least invasive procedure among the existing types of thyroid surgery here.

Instead of operating through the neck, chest or armpit as in other types of thyroid surgery, the surgeon operates through the patient's inner lower lip, which hides any wounds.

Three incisions measuring 5mm to 10mm each are made to allow a camera and endoscopic instruments to be inserted into the chin and neck area.

Air is then used to open up space, before tissues are carefully dissected to reach the thyroid gland, which is then removed.

The entire procedure takes about two to three hours. Patients who undergo this procedure typically stay in the hospital for two to three days.

While conventional thyroid surgery is faster at about one to two hours and has a low complication rate, it can leave a visible scar across the neck.

Other surgery options also leave scars on the chest and armpit, and may cost up to $10,000 in out-of-pocket fees.

The transoral method, however, costs about $2,000 in cash for a patient in a Class B2 ward - similar to conventional surgery.

After her operation, Ms Mak experienced swelling in her neck and chin area and could not talk for two weeks, which is common for the procedure.

"I couldn't really see the scars. When I pulled open my lower lip, all I could see were surgical threads," said Ms Mak, who stayed in the hospital for three days.

"The wounds heal faster than wounds on the skin," she added.

As the surgery is still relatively new in Singapore, Dr Ng said it is typically performed for patients who have no previous neck or thyroid surgery and have a lump no bigger than 3cm in diameter.

Patients who are obese, or have a large thyroid or advanced thyroid cancer are not suitable for the procedure.