How is thyroid cancer diagnosed and treated at the American Hospital of Paris?
Diagnoses are made by our endocrinologists and thyroidologists. If an undetermined or cancerous tumor is suspected or detected, surgical treatment is discussed during a multidisciplinary team meeting.
What exams are necessary before treatment?
All the exams that are needed for the diagnosis as well as any preoperative exams can be performed at the American Hospital of Paris. The Hospital features latest-generation diagnostic and testing technology including a high-precision ultrasound system and a scintigraphy device, coupled with internationally renowned specialists: thyroidologist, nuclear medicine specialist, anatomical pathologist and cytotechnologist specialized in thyroid tumors. This enables extremely accurate thyroid tumor diagnostics.
Once the required tests have been performed, a multidisciplinary team meeting is held to determine whether surgery is appropriate.
The American Hospital of Paris offers the advantage of treating thyroid tumors using a surgical robot. A Korean surgeon developed a transaxillary (underarm) robot-assisted technique which makes it possible to hide the scar. In ten years, the American Hospital of Paris has performed this procedure on more than 1,200 patients 1.
When it comes to the treatment of thyroid cancer in private hospitals, the American Hospital of Paris ranks first in the Paris region and seventh in France. At 88 per cent, it boasts the highest rate of public recognition in France for thyroid cancer care.
What are the benefits of this technique?
The surgeon makes a unilateral transaxillary incision (under the arm) and peels back the skin. Next, the robot is positioned. Its miniaturized instruments ensure extreme precision for thyroid gland dissection2.
Unilateral gland surgery takes an average of 50 minutes, while total ablation takes approximately 80 minutes. The lymph nodes surrounding the gland can be removed at the same time if necessary.
This technique offers two major advantages: surgical precision and the absence of a neck scar.
- Surgical precision
The robotic instruments are extremely small and maneuverable, allowing the surgeon to very precisely dissect the recurrent laryngeal nerve, which supplies motor function to the vocal chords, and the parathyroid glands, which regulate calcium secretion.
- Cosmetic outcome and absence of neck scar
Patients, in particular younger women with thyroid disorders, are reluctant to live with a scar in the middle of their neck. This type of scar is highly visible in Western countries, where the neck is rarely covered, and patients prefer to conceal such evidence of surgery or of certain disorders. The problem is exacerbated in patients who have difficulty scarring or who generally present keloid scars, as a visible scar has potential psychological, social and even professional repercussions.
Thanks to this technique, patients benefit from a procedure that is less invasive than traditional thyroid surgery and leaves no visible scar.
How is treatment organized at the American Hospital of Paris?
During the preoperative consultation with the surgeon, the entire procedure is explained to the patient and a date is scheduled for the operation. The patient is admitted to the Hospital on the morning of the procedure and can usually leave after one or two days. An initial analysis of the tumor is conducted during the operation, and a definitive analysis is provided to the surgeon one week later. The exact diagnosis is then announced to the patient by their doctor.
What are the outcomes of robot-assisted thyroid surgery?
Robot-assisted surgery produces excellent results and the rate of complications is very low compared to traditional surgery. It is very difficult to provide exact figures and to compare this technique against traditional open thyroid surgery. Outcomes depend on the patient’s pathology, anatomy and most of all on the surgeon’s experience using the robot. While both techniques are used, the robot offers incredibly high-quality surgical vision.
Thanks to the robot, the dissection is much more precise. The transaxillary approach allows the surgeon to access the gland laterally, which enables immediate contact with the structures to be preserved, namely the recurrent laryngeal nerve and the parathyroid glands.
Are there any side effects?
Patients report very little pain after the procedure, usually limited to slight discomfort under the skin in the neck, which subsides very quickly. Patients can quickly resume arm movement on the side that was operated. There is zero risk of complications for a subsequent breast tumor or axillary node dissection, since the surgeon passes under the skin without intersecting any fatty tissue, which also ensures a much higher degree of precision.
The incision, which is only four to five centimeters long, is sealed with glue, enabling the patient to shower and eliminating the need to have stitches removed one week later.
What about follow-up care?
The surgeon sees the patient again one week after the procedure, after receiving the diagnosis which is as accurate as possible. In the case of a significant tumor disease, a multidisciplinary team meeting is held to discuss the possibility of radioactive iodine treatment. This two-day treatment is delivered in collaboration with the Paris public hospital system (APHP) and offers very positive outcomes.
When treated early, the recovery rate for thyroid cancer is between 98 and 100 per cent. 3
When treated early, the recovery rate for thyroid cancer is between 98 and 100 per cent. (3)
Sources & crédits
1 Patrick Aïdan, G. Boccara, N. Beressi, H. Monpeyssen: Chirurgie thyroïdienne et parathyroïdienne au Robot par voie axillaire. Annales d Endocrinologie 09/2012; 73(4):307., DOI:10.1016/j.ando.2012.07.249
2 Patrick Aïdan, Maroun Bechara: Gasless trans-axillary robotic thyroidectomy: The introduction and principle. 06/2017; 6(3):229-235., DOI:10.21037/gs.2017.03.19
3 Surveillance Epidemiology and End Results (SEER), National Cancer Institute. (2014, November). SEER Stat Fact Sheets: Thyroid Cancer. Bethesda, MD: National Cancer Institute.