S156 – What Can Determine the Length of a Thyroidectomy Incision?

Abstract

Objectives Patient expectations regarding cosmesis following surgical procedures have increased. Subsequently, many surgeons are now utilizing very small incisions when performing thyroidectomy. This study evaluated the association between patient weight, nodule size, and maximum thyroid diameter, and the length of a thyroidectomy incision. Methods Data from a cohort of 28 consecutive patients treated by a single surgeon was analyzed. Patient demographics, clinical exam, ultrasound findings, operative findings, and pathology were recorded. All incisions were measured pre-operatively. Results Of the 28 patients (79% female), 24 underwent a hemithyroidectomy and isthmusectomy. One patient had papillary thyroid cancer and 7 (25%) required operation for compressive symptoms. The mean patient weight was 200.76 lbs (median=188 lbs; IQR 75lbs). The mean clinical nodule diameter was 3.64 cm (median=3.7 cm; IQR=1.7 cm), and the mean maximum thyroid diameter was 6.22 cm (median=5.25 cm; IQR=3.7 cm). The mean incision size was 5.32 cm (median=5.0 cm; IQR=2.0 cm). Independently, patient weight, maximum thyroid diameter, and maximum nodule diameter were shown in regression models to be statistically significant predictors of incision size. In stepwise regression analysis that included all three listed variables, only maximum thyroid diameter remained a significant predictor of incision size (p<0.0001). Conclusions The use of small incisions when performing thyroidectomy is becoming common. To further reduce incision size, video-assisted thyroidectomy is now being advocated. For thyroidectomy, surgeon preference and comfort level are obviously important factors in deciding incision length. This retrospective study has shown that this decision is taken in context of the patients’ weight, maximum nodule diameter, and most importantly, maximum thyroid diameter.