Minimally Invasive Surgery Procedures
The surgeons are dedicated to using the most innovative techniques to treat patients with thyroid diseases, parathyroid diseases and adrenal gland disorders. The surgeons who are trained in robotics at Mount Sinai perform minimally invasive thyroid surgery using the da Vinci® system. This technique is designed to produce excellent cosmetic outcomes with no neck scarring. In addition, it avoids laryngeal nerve injury.
Minimally invasive surgery procedures work by allowing surgeons to use small instruments that mimic their hand movements, making small places that are difficult to reach with human hands, much easier to access. This advanced method of surgery also offers physicians a three-dimensional color view of the area, allowing for a more precise operation, as opposed to the traditional two-dimensional view. There are a number of minimally invasive procedures offered at Mount Sinai, performed by surgeons who are leaders in their respective fields.
Remote Access (Hidden Scar) Approaches
Mount Sinai Health System Endocrine surgeons provide the highest quality care and a multidisciplinary approach for treating your endocrine health concerns including thyroid, parathyroid, adrenal, and neuroendocrine pancreas disorders. Our surgeons at Mount Sinai are the world leading authorities in remote access “hidden scar” thyroid and parathyroid surgeries providing some of the most innovative surgical techniques that employ the latest endoscopic and robotic technology.
Remote, Robotic, and Hidden Scar Approaches
The endocrine surgery program at Mount Sinai is the only program in the United States to offer all three hidden scar approaches.
Transaxillary endoscopic thyroid surgery – This approach involves making one incision at the armpit and use the advanced endoscopic instruments to perform a partial thyroidectomy for benign thyroid diseases or small thyroid cancers.
Bilateral axillo-breast approach robotic thyroid surgery (BABA) – This approach utilizes the latest robotic technology for both large benign thyroid disorders and even advanced thyroid cancers. Dr. Hyunsuk Suh and Dr. William Inabnet performed the first BABA robotic thyroidectomy as well as the first BABA lymph node dissections in the United States. BABA approaches utilize four small incisions at the natural skin creases of the armpit and around the areola. Robotic instruments and a 3D camera are used for optimal safety and complete cancer surgery outcomes.
Transoral Endoscopic Thyroidectomy Vestibular Approach (TOETVA) – This latest approach involves an incision in the lower lip to insert endoscopic instruments through the mouth. Dr. Inabnet, Dr. Gustavo Fernandez-Ranvier, and Dr. Suh performed one of the first TOETVA surgeries in the US. This approach is being offered mainly for benign thyroid disorders.
Endocrine Surgery Thyroid Program
Ultrasound-guided FNA of Thyroid Nodules
Ultrasound guided fine needle aspiration biopsy of thyroid nodules is performed in the Endocrine Surgery Thyroid Program by the surgical team. If a thyroid or other neck nodule is identified at the time of consultation, then the surgeon may recommend a fine needle biopsy to obtain needed information. The surgeon can then further advise on the next step in patient care. Our surgeons are very experienced at performing ultrasounds on their patients, giving them a window that shows the anatomy of the thyroid gland. Any suspicious nodule can be immediately biopsied. A clean, protected ultrasound probe is placed on the neck with ultrasound gel. The surgeon thoroughly examines the thyroid gland and the other structures of the neck to provide a map of both the normal and abnormal tissues. A very skinny, thin needle is then placed through the skin and directly into the concerning nodule under the guidance of the ultrasound. The needle is then removed and the contents are sprayed into a liquid medium or slide, which is then sent to the laboratory for analysis. Our expert cytopathologists look at the cells under a microscope and then give the surgeons a report, which guides further decision-making regarding the thyroid nodules. Patients are generally very happy with the experience of the needle biopsy and our yield of diagnostic results is very high. The procedure itself is very safe.
Mini-incision thyroidectomy is a procedure that minimizes surgery. A very small incision, (between two and four centimeters or 1 inch) is made along a natural skin crease in the neck to minimize the visibility of the scar. The incision is made as small as possible, given the size of the thyroid gland and the size of the patient. But the incision is made large enough to complete the operation safely with priority given to properly identifying and preserving the laryngeal nerves and the parathyroid glands. The small incision leads to a better cosmetic result and also decreases pain and speeds along recovery. Patients are generally very pleased with their results. If desired, this operation can be performed under local anesthesia with intravenous sedation. More than 85 percent of our mini-incision thyroid patients are discharged the same day of surgery.
Minimally Invasive Endoscopic Thyroidectomy
The surgeons at the Endocrine Surgery Thyroid Program have pioneered endoscopic approaches to thyroid gland. In 1998, Dr. William B. Inabnet III performed the first endoscopic thyroid procedure in the United States, (at Mount Sinai) which was also the third such case in the world. Since then, numerous refinements in endoscopic thyroid techniques have led to improvements to this approach of removing the thyroid gland. With the endoscopic transaxillary approach, a small incision is made in the axilla under the arm. A small camera (endoscope) is inserted in the tunnel to allow visualization of the thyroid gland and surrounding anatomy. The endoscopic view provides an illuminated, magnified view of the operative field, permitting the surgeon to perform a safe thyroid procedure. Our surgeons can perform partial or total thyroid removal with this approach, including patients with stage 1 thyroid cancer and Graves' disease. In addition to the improved view of thyroid anatomy, the main advantage of endoscopic thyroidectomy is that the incision and subsequent scar are in a hidden location, meaning there is no scar on the neck. The surgeons at the Endocrine Surgery Thyroid Program are also developing other endoscopic approaches to thyroid gland, such as the breast approach where the incisions are made around the areola (nipple complex) of the breast. With the breast endoscopic approach, the incisions are truly in a hidden location. More than 70 percent of our endoscopic thyroid patients are discharged the same day of surgery.
Video-assisted Neck Dissection for Thyroid Cancer
The surgeons at the Endocrine Surgery Thyroid Program have developed a novel technique for performing minimally invasive node removal for patients with thyroid cancer and lateral lymph node metastases. Total thyroid removal with lateral neck node dissection typically necessitates a large (six inches), potentially disfiguring scar on the neck. With the video-assisted approach, total thyroid removal is performed through a one inch incision. A video-endoscope is then inserted directly into the wound to allow the surgeon to perform the neck dissection through the small incision. The operative field is illuminated, well lit and viewed on a high definition monitor in the operating room. Complete node removal is performed through the small incision, thereby avoiding a cosmetically unfavorable scar.
Minimally invasive Thyroidectomy under Local Anesthesia
The surgeons at the Endocrine Surgery Thyroid Program have pioneered thyroid removal under local anesthesia. With this approach, the surgeon administers the local anesthesia in the operating room. Our dedicated thyroid anesthesia team administers light sedation so that most patients have no recall of the operation. A mini-incision thyroid operation is then performed as described above. Advantages of this approach include the avoidance of general anesthesia, improved pain control and a very quick recovery. More than 90 percent of patients undergoing thyroidectomy under local anesthesia are discharged the same day of surgery.
Endocrine Surgery Parathyroid Center
Minimally Invasive Parathyroidectomy under Local Anesthesia
Minimally invasive parathyroid surgery under local anesthesia is the method of choice for the surgeons at the Endocrine Surgery Parathyroid Center to treat hyperparathyroidism. The procedure involves removal of one or all of the parathyroid organs.
Bilateral Neck Exploration for Hyperparathyroidism
The surgeons at the Endocrine Surgery Parathyroid Center have considerable experience in treating even the most complicated parathyroid conditions with bilateral neck exploration. If necessary, all of the diseased parathyroid glands will be identified and appropriately treated, usually under local anesthesia.
Minimally Invasive Endoscopic Parathyroidectomy
The surgeons at the Endocrine Surgery Parathyroid Center perform video-endoscopic parathyroidectomy removal using a small camera to allow visualization of the thyroid and parathyroid glands, permitting the surgeon to perform a safe parathyroid procedure.
The surgeons at the Mount Sinai Adrenal Center are trained in advanced laparoscopic techniques. Worldwide, laparoscopic adrenalectomy has become the standard approach for adrenal gland removal for benign adrenal conditions. With this approach, a laparoscope (small endoscopic camera) is inserted into the abdomen through a small incision. The adrenal gland is approached and removed using specialized laparoscopic equipment. A high definition image of the operative field is viewed on a monitor, allowing the surgeon to safely remove the adrenal gland with minimally invasive techniques. Our surgeons perform both the standard transabdominal approach (where the small incisions are located on the front of the abdomen); or the more direct retroperitoneal approach (where the incisions are located on the back). During the patient's hospital stay, they are evaluated by the interdisciplinary Adrenal Center team, which is comprised of endocrine surgeons, endocrinologists and cardiologists who work together to implement a comprehensive care plan. Most patients are discharged the day after surgery.
Laparoscopic Pancreatic Surgery
The surgeons in the Division of Metabolic, Endocrine and Minimally Invasive Surgery have pioneered novel laparoscopic techniques, including laparoscopic pancreatic resection. Our surgeons perform a variety of laparoscopic pancreatic techniques such as enucleation of pancreatic neuroendocrine tumors (PNETs), distal pancreatic removal and laparoscopic pseudocyst drainage. Working closely with our program's interventional gastroenterologists, a comprehensive preoperative assessment is performed to create an interdisciplinary care plan. With minimally invasive laparoscopic pancreatic surgery, a laparoscope (small endoscopic camera) is inserted into the abdomen through a small incision. The pancreas is approached using specialized laparoscopic equipment. A high definition image of the operative field is viewed on a monitor, allowing the surgeon to safely perform the pancreatic procedure with minimally invasive techniques. Since our surgeons are members of the Mount Sinai Endocrine Neoplasia Program, we specialize in treating neuroendocrine tumors of the pancreas including insulinomas, gastrinomas and non-functioning PNETs.
Mount Sinai Union Square
Fax: 212-202-4713 or 212-202-4995
The Garlock Division of General Surgery
5 East 98th Street
3rd Floor (Mail Box 1259)
New York, NY 10029
1470 Madison Ave at 101st Street
3rd Floor (Mail Box 1259)
New York, NY 10029