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Thomas' Technique - Thyroid Surgery!

As we all know thyroid surgery is one of the commonest surgeries done in any hospital across the globe. Theodore Kocher got Nobel Prize for his work on Thyroid way back in 1890 during an era when we had no ultrasonography, CT scan, MRI or functional scans or the philosophy of compartments in the neck were unknown.

122 years down the line we still follow Kocher’s principles of thyroid surgery at a time when we even have 3 D CT scans and sonograms.

3-D-digital interactive anatomy helps surgeons and all clinicians to understand anatomy in a different perspective.
As we focus on central compartment in the Neck, we realize that the only part of the thyroid that occupy mid line position is the isthmus while the lobes are lateral to trachea and esophagus with its blood supply lateral and posterior, the parathyroid posterior and medial and the nerves too postero-lateral and medial to the gland.

We also realize that in conventional Kochers’ approach we approach these vital structures from front causing
un necessary hemorrhage while handling the gland which in turn  stains the bed of surgery making the identification of parathyroids and nerves a difficult task.

Is it not true that in Kocher’s thyroid surgery is a procedure which is intended to control hemorrhage from the start (at the level of each facial planes?)
 All the known complications in thyroid surgery are thus due to faulty approach.  This occurs more frequently in large multi nodular goiters. There are several instances where the recurrent laryngeal nerve will be within the huge goiter.
In Thomas’technique of horizontal lateral thyroidectomy, the vessels are ligated upfront, the parathyroids are saved in a clean field and the nerves (sup and recurrent) are identified and protected upfront.

In fact thyroid surgery is done primarily to protect these structures at risk.!!

This approach will cut off the blood supply to the gland and shrinks the tumor.

In reality one is operating on an avascular gland! And the blood loss ranges from 2-5 ml.

As surgeons we know that platysma muscle is deficient in the mid line in the neck and Kocher's incision is placed exactly where the deficiency of platysma is maximum but laterally it cuts the platysma hence while the wound heals the contracting platysma on either side pulls the scar to either side and it results in an ugly scar in a large majority.

Lateral incision which cuts platysma completely only on one side even in totat thyroidectomy or total thyroidectomy with MND and Central compartment clearance (which will never come to the central deficient area )gives superior cosmetic scar which disappears completely in more than 99%,in 6-8 months’ time.
 The subcutaneous rich interconnection of blood vessels is maximum in the anterior aspect of the neck which needs be ligated in conventional approach which adds to neck edema. In Horizontal lateral approach these blood vessels are un touched as we go laterally and posteriorly.

In my technique no patient remains in the hospital beyond 24 hrs. This helps favorably for health economics. Early discharge benefits the patient and the hospital. (The only time when both parties win)

Such a novel approach BASED ON 3 D INTERACTIVE DIGITAL ANATOMY is described for the first time in the world literature and it is truly a scar less thyroid surgery and much superior to the conventional thyroid surgery in that the complications like Nerve Injuries, parathyroid deficiencies, or hemorrhage are almost nil.

It is minimally invasive since from one ipsilateral incision total thyroidectomy also is undertaken.(unilateral incision and total thyroidectomy !)

This technique is suitable for any age, gender, pathology,physiological status and any tumor size including intra thoracic.

It is a tribute to the world from God’s own country.