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Robotic thyroid surgery means no neck scarring for patients

By Doug Boyd

Lauren Castelloe shows where a surgeon made incisions to remove a growth from her thyroid gland using a robot-assisted surgical technique. Photos by Cliff Hollis
GREENVILLE, N.C.   (July 7, 2011)   —   Lauren Castelloe recently had thyroid surgery, but you would never know by looking at her neck.

That's because robot-assisted surgery is giving patients in eastern North Carolina the option of less visible scarring following thyroid operations.

Dr. Walter Pofahl, a surgeon at the Brody School of Medicine at East Carolina University, performed the first robot-assisted thyroidectomy in the state a few weeks ago.

"At this point the main advantage is that the incision is hidden from view. It is more cosmetically appealing," said Pofahl, an associate professor and chief of advanced laparoscopic, gastrointestinal and endocrine surgery. "However, in the future it is hoped that we will be able to undertake larger dissections through a small incision and avoid the problems of large incisions on the neck."

The thyroid is one of the body's main endocrine glands. It's in the neck, below the Adam's apple. Thyroidectomy is the surgical removal of all or part of the thyroid gland. Surgeons perform a thyroidectomy when a patient has thyroid cancer, an abnormal biopsy or an enlargement causing symptoms (goiter).

Most thyroidectomies are now performed with an incision in the neck that is several inches long. Pofahl performed Castelloe's operation through small incisions near her armpit. Using a robotic system is novel but not unexpected at ECU. The university, together with Pitt County Memorial Hospital, is one of the nation's leading robotic surgery sites where surgeons conducted clinical trials of robotic surgery in the late 1990s and early 2000s.

"Knowing our background in this area, the ability to have the right people working together to make this a success was never in doubt," Pofahl said. "This, coupled with a large thyroid surgery practice, assured the success of this initial case. I anticipate continued growth in this particular area of thyroid surgery here."

With the DaVinci robotic system, the surgeon sits at a console a few feet from the patient on the operating table. The surgeon controls a set of robotic arms that hold surgical instruments and are inserted into the patient through tiny incisions. Working controls at the console while watching through a monitor, the surgeon guides the arms to perform the operation. The system has the advantage of 3D visualization and instruments that are more versatile than traditional laparoscopic instruments.

Castelloe, who lives in Windsor, had a benign goiter that was found during an ultrasound class at Pitt Community College in 2007. "Oh, you have a little cyst on your thyroid gland," she said her classmate told her. A visit to a doctor confirmed it. The growth was small and not much to worry about immediately, though over time it would grow and need to be removed.

In the spring, Castelloe's endocrinologist referred her to Pofahl for surgery. "It was just one of those things where it was going to keep growing," she said during a follow-up visit to Pofahl in June. "He (Pofahl) said I was a perfect candidate for robotics."

Castelloe, 27, worked Memorial Day then had surgery in Greenville the next day and spent one night at PCMH. She returned to her job as a sonographer at Roanoke-Chowan Hospital in Ahoskie eight days later. She's happy with the results of the surgery, but said she's had soreness in her lower neck where the instruments passed through on their way from her armpit to her thyroid. Pofahl said such soreness is normal and dissipates over a few weeks.

"I was happy not to have a big scar on my neck, so that made a difference," she said.

The surgery does take a little longer than traditional surgery, Pofahl said.

At this time robotic thyroid surgery is limited to small nodules in patients with an appropriately small body size and weight. As the experience grows, Pofahl anticipates being able to perform the procedure in a larger group of patients.

Dr. Walter Pofahl talks with patient Lauren Castelloe recently at the ECU Physicians surgery clinic.
Dr. Walter Pofahl talks with patient Lauren Castelloe recently at the ECU Physicians surgery clinic.


Contact: Doug Boyd | 252-744-2482