The Medical City Offers a New Option for Thyroid Surgery

People may discover an abnormal lump or mass in their neck accidentally. Sometimes, doctors discover a neck lump during a routine physical examination. A lump in the neck can be the first sign of certain cancers, including cancer of the thyroid gland.

"Papillary thyroid cancer is the most common form of thyroid cancer. But, if diagnosed early, it is also the most treatable," says Dr. Daniel Alonzo, Head and Neck Cancer Surgeon and Director of the Cancer Center of The Medical City (TMC).

Dr. Alonzo also says that the first line of treatment for this type of cancer is a procedure known as a thyroidectomy. A total thyroidectomy is a surgical procedure where the entire thyroid gland is removed. A partial thyroidectomy (removal of only one side) may be done for certain patients with small nodules located in only one lobe of the gland.

There are three ways of doing thyroid surgery namely the conventional open surgery, endoscopic, and robot-assisted thyroid surgery. 

"At The Medical City, we have been doing a substantial number of thyroid surgeries every year and robot-assisted thyroid surgery is the latest addition to our armamentarium," says Dr. Alonzo.

Robot-assisted transaxillary thyroidectomy eliminates the unsightly neck scar by accessing the thyroid gland through an incision under the arm. It is performed at TMC using the da Vinci Si Surgical System, which is also being used for other head and neck tumors located in the tongue, throat, and voice box. The robot is utilized for urologic, colorectal, thoracic, gynecological and other general surgery procedures. 

The main advantage of using this technique is the improved visualization for the surgeon, increased precision through elimination of the surgeon’s natural tremor, and theabsence of a neck scar, which  usually measures four to five centimeters.

"However, robot-assisted thyroidectomy is not a viable treatment option for everyone. It is not suitable  for patients with huge thyroid nodules," says Dr. Alonzo.

Rachel and husband Pierre

Rachel's Story

Rachel Cruz first felt a lump on the left side of her neck in September 2016.

"At the time, I thought it was just the usual kulani or lymph nodes," relates the 37-year-old Rachel, who works as a Human Resource and Admin head in an automotive business office in Taytay, Rizal.

After one month, the lump was still there. Rachel and her husband decided to go to the Emergency Department in another hospital. The doctor at the ED advised her to see a surgeon or an endocrinologist.

On October 5, 2016, Rachel went to The Medical City to see Dr. Mary Queen Villegas-Florencio, TMC Endocrinologist, who ordered thyroid function tests and ultrasound of the thyroid gland. The ultrasound revealed three thyroid nodules. Rachel was then advised to undergo Fine Needle Aspiration Biopsy (FNAB) to determine the exact nature of the nodules.

FNAB results showed features suspicious for cystic papillary thyroid carcinoma. After FNAB, surgery was recommended and Rachel was referred to Dr. Alonzo by a friend. After a thorough physical examination and review of all of the information, Dr. Alonzo presented all of the treatment options.

"First, he asked us if we would consider a total or partial thyroidectomy.. Then he explained the two types of surgery which are conventional open surgery and robotics," says Rachel.

She underwent robotic transaxillary partial thyroidectomy in November 2016 at TMC. This type of robotic surgery is performed by accessing the thyroid gland through an incision under the arm thus, eliminating the neck scar. Dr. Alonzo was assisted by Dr. Samantha Castañeda and Dr.Argelyn Ong, also head and neck surgeons, during the procedure.

"The real diagnosis came after I had my left thyroid taken out for further tests. It revealed I had adenomatous colloid/ multi-nodular goiter. When I learned about it, it felt like the biggest reprieve. Overwhelming joy, relief and gratefulness was how I could best describe the feeling," shares Rachel.

Rachel is thankful to Dr. Alonzo, Dr. Castañeda, and Dr. Ong for the safe and successful procedure and for giving her the option to undergo robotic surgery.

"When faced with the option of surgery for my thyroid condition, I never thought of robotic surgery. Since I am a fan of TMC’s official Facebook page, I saw a post about it once, yet I never thought it would become a medical option for me one day," reveals Rachel.

She also asked her family and friends about her dilemma prior to the surgery. She was to choose between open surgery and robotics.

"I was further convinced to have robotic surgery when I conducted a poll among my family and colleagues. I explained to them some pros and cons based on the research I conducted  and even showed them a video of how it would be done. All of the people I asked told me they would go for robotics. Only one said she would go for  open surgery," says Rachel.

Rachel did her research about robotic surgery by watching YouTube videos and by referring to the TMC Facebook post about the advantages of this minimally invasive procedure over conventional open surgery.

"The fact that the doctor can view what’s inside me through a high definition camera and can be magnified to about 10x made me believe this kind of surgery could truly be less invasive. " she adds.

Rachel also appreciates, as a bonus, that she does not have any visible scar especially on her neck since the incision was done under the arm.

"After my surgery, I find it cool when people try to look for the scars on my neck and I tell them it didn’t go through there, then they ask me where the incision was," says Rachel.

She is grateful for the compassionate care given to her by her doctors and by the nurses and staff at TMC.

"When I was inside the surgery suite, everyone – doctors, nurses and nursing assistants – made me feel at ease. I was surprised because they brought me inside while I was still fully conscious. I even saw how the da Vinci Robot looked like up close, and the console where the surgeon will be sitting on to perform the procedure."

"While the equipment looked very intimidating, I never felt nervous while I was there. It felt like I was in the set of transformers, seriously," says Rachel.

Everything is back to normal now for Rachel. "Now I can already carry my five-year old son again, raise up my left arm and carry heavy stuff. I was advised to visit my doctor once a month for follow up." says Rachel.