Rockwood, with Deaconess Hospital, offers advanced daVinci robotic thyroidectomy. Renu Sinha, M.D., FACS, performed the first robotic thyroidectomy in Eastern Washington in April 2011 at Deaconess.
Dr. Sinha received her robotic training through MD Anderson Cancer Center and with Woong Youn Chung, M.D., who pioneered the procedure. Dr. Sinha is one of a select group of high-volume thyroid surgeons in the U.S. trained to perform this procedure.
The da Vinci® Surgical System provides excellent visualization of critical structures for the surgeon. The primary benefit for patients undergoing robotic thyroidectomy is improved cosmetic outcome by avoiding a scar on the neck.
Dr. Sinha joined Rockwood in 2007 with a special interest in breast and thyroid cancer surgery. She is board certified in surgery and a member of the American Association of Endocrine Surgeons.
For more information on endocrine surgery, visit the web site of the American Association of Endocrine Surgeons at American Association of Endocrine Surgeons.
Spokane Coeur d'Alene Living magazine tells the story of the first two robotic thyroidectomies in eastern Washington. The article is reprinted below with permission.
Robotic Thyroid Surgery
No neck scar, faster healing
By Julie Holland
When Karen Leach, a Spokane mother of six-year-old triplets, first discovered she had a growing lump on her throat, she didn't panic. Her physician husband and her nurse stepmother were quick to encourage her to see a specialist, but they were just as quick to ease her concerns.
"I didn't have a lot of fear," says Leach."Even in the worst case scenario, I wasn't in fear for my life. But the thought of having to get it checked out every six months and having biopsies, that was troublesome."
Leach's family members believed she had a growing nodule on her thyroid, and they were right.
Thyroid nodules are fairly common in women. According to some statistics, one in every 12-15 women and one in every 50 men have thyroid nodules. On the bright side, more than 95 percent of those nodules do not test positive for cancer cells.
A thyroid nodule is a lump or swollen area in the lower front of the throat, located in or on the thyroid gland. The thyroid gland produces hormones that are important for the function of cells in the body, including growth, heart rate, body temperature, blood pressure and metabolism. The thyroid gland wraps around the windpipe and is shaped like a butterfly with left and right wings or "lobes". The thyroid gland uses iodine, found in iodized salt and some foods, to make the necessary hormones. When the thyroid gland isn't functioning correctly, it can result in energy loss or an abundance of energy that can negatively affect the body's growth, metabolism and organ function. With thyroid nodules, the symptoms can vary.
"Sometimes patients have an obvious lump associated with fatigue, hair loss or swallowing problems," says Renu Sinha, M.D., FACS, an endocrine surgeon with Rockwood Clinic. "But most patients don't have any symptoms at all." Dr. Sinha says nodules are an overgrowth of normal thyroid tissue, inflammation, cysts, benign or malignant tumors.
"If you have a thyroid nodule, it doesn't necessarily mean you need surgical treatment," says Dr. Sinha. "Most nodules are benign, but some can be harboring cancer. I want to identify those patients at risk and use the latest technologies available for providing them with appropriate treatment."
For most patients with an obvious thyroid nodule, a physician specialist conducts an examination, orders blood work to evaluate the patient's thyroid hormone levels, conducts an ultrasound to see if the nodule is solid or fluid-filled and orders a needle biopsy to obtain cells for testing. While only about five percent of thyroid nodules test positive for cancer, other issues can make surgical removal of the nodule the best option for treatment.
"Even if the nodule is not cancerous, it could be suspicious or
problematic in other ways," says Dr. Sinha. "It could grow and
cause swallowing or breathing problems for patients."
Retired nurse Addie Sallquist's thyroid nodule wasn't visible on her throat, but it caused enough problems that she sought a check-up from her cardiologist. During a carotid ultrasound screening, her doctor found a large growth on her thyroid that was placing pressure on her artery. Sallquist immediately made an appointment with an endocrine specialist for further testing.
"My biopsy was negative for cancer," says Sallquist, "but the nodule had grown significantly in a year and I was starting to get this weird dizziness from the pressure on my carotid artery." For Sallquist, surgical removal of the nodule was her best option. That's when she heard about the new robotic thyroidectomy procedure being offered by Dr. Sinha at Deaconess Medical Center.
First robotic thyroidectomies in Spokane
With traditional thyroidectomy, the surgeon makes a two-inch incision in the throat to remove the thyroid lobe containing the nodule. With the new robotic thyroidectomy procedure, specially trained surgeons perform minimally invasive surgery with the da Vinci® robotic system. A two-inch incision is made through the patient's armpit area.
"We don't have to cut through any muscle to get to the thyroid," says Dr. Sinha, "which results in quicker healing time for the patient and less swelling in the surgical area. The robotic instruments are small and cause less trauma to the patient. In addition, the 3-D visualization provided by the robotic system provides more comfort, less eye strain and greater accuracy for the surgeon."
This past April 25, Dr. Sinha performed the first robotic thyroidectomies in Eastern Washington at Deaconess Medical Center. The cases were also among the first robotic thyroid procedures performed in the state of Washington. In fact, Dr. Sinha is one of a select group of high-volume thyroid surgeons trained to perform robotic thyroidectomy procedures in the United States.
"The robot mirrors the surgeon's movements exactly," says Dr. Sinha. "It's a very surreal experience at first. With this technology, you can still feel structures with your fingers, you just feel them in a completely different way."
Although Dr. Sinha has performed thousands of traditional thyroidectomies in her career as an endocrine surgeon, she recently received robotic training from world-renowned endocrine surgeon Woong Youn Chung, M.D., Ph.D, and his team from Yonsei University College of Medicine in Seoul, Korea, with the faculty from MD Anderson Cancer Center in Houston, Texas.
Dr. Chung pioneered the procedure in 2007 and has since performed more than 2,100 robotic thyroidectomy cases. In the U.S.,robotic thyroidectomies have only been performed since the procedure was approved by the Federal Drug Administration in December 2009. Karen Wohlen, M.D., also trained with Dr. Chung in Houston and assists Dr. Sinha during the procedure, which requires a physician at the patient's side and a surgeon at the robotic console.
"It was truly an honor to get hands-on training with Dr. Chung," says Dr. Sinha. "When I was approached with this opportunity, I knew I wanted to learn from the very best. Dr. Chung is an endocrine surgeon with the world's most extensive experience in this particular procedure. He's known for doing five or six robotic thyroidectomies a day."
With the high volume of robotic procedures performed by Dr. Chung and the high number of traditional thyroidectomies performed by Dr. Sinha, the learning curve was not as steep as it might have been. "I was very impressed with his technique," says Dr. Sinha. "Dr. Chung performs the robotic procedure with such finesse and accuracy. During every procedure, I want to emulate that."
Cutting edge surgery - close to home
"My goal was to bring this technique to our community," says Dr. Sinha. "We see many patients with thyroid nodules at Rockwood every month. To be an appropriate candidate for robotic thyroidectomy, patients must have the right type of nodule, be in good general health and meet set height and weight requirements. Above all, we want this operation to have clear benefits for each patient."
Those benefits include quicker healing and recovery time, less swelling and soreness in the throat, not to mention a greater aesthetic outcome. "There's no scar on the neck," says Dr. Sinha, "which is a huge benefit for young patients - especially women. In addition, scarring on the neck can also lead to swallowing problems. Without the incision in the neck, those problems can be avoided."
While some patients may be hesitant about trying robotic surgery, it is becoming the norm in several areas of medicine, including heart, prostate and gynecologic surgeries. "Robotic thyroidectomies are just as safe as the traditional method," says Dr. Sinha. "With the 3-D camera and the magnified vision, surgeons also have improved visualization of the surgical area. With the improved ability to see, the procedure is safer and the risk of nerve injury is diminished."
Two patients, two success stories
For Leach and Sallquist, the first two patients in Eastern Washington to undergo the robotic thyroidectomy procedure, the results were more than satisfactory. "From an aesthetic standpoint, it has obvious advantages because you won't have a scar in the middle of your neck," says Leach. "I don't scar well. I have other scars that have stayed red for years and have never faded to a light white color. If I have to have a scar, I'd rather have it under my arm than in a visible location on my neck."
In addition, Leach says her recovery wasn't nearly as difficult as she imagined. "I was surprised that I didn't have a lot of pain," says Leach. "I had superficial irritation for a few weeks, but it definitely wasn't as bad as I thought it would be. I had some atypical cells, but the growth wasn't malignant. I consider myself lucky."
As a former nurse with many years of expertise in cardiac medicine, Sallquist expected the worst, but was pleasantly surprised. "My whole recovery was uneventful," she says. "I was very nervous about the surgery, but I was just amazed at how well it went. Dr. Sinha instilled so much confidence, which is unusual for me," Sallquist says with a laugh. "After I met with her I thought, if anyone can do this, she can!"
For Dr. Sinha, bringing this cutting-edge procedure right here to Spokane with the help of Rockwood and Deaconess has been quite an accomplishment. For Sallquist, it's a relief and a blessing. "I'm glad it's gone," she says. "I just can't tell you how wonderful the experience was. I expected pain, soreness or at least a sore throat - but I didn't have any trouble at all."
The wave of the future
"Robotic surgery is a constantly growing field of medicine," says Dr. Sinha, who earned her medical degree from The Ohio State University, completed residency and fellowship programs at the University of California-Davis and The Ohio State University and served as an associate professor of surgery at the University of Arizona College of Medicine. "Robotic technology will continue to make surgery more accessible and safe for areas of the body that are anatomically difficult to reach, such as the oral cavity, chest and base of the skull."
"We want to provide our patients with the safest, most accurate, least painful surgery possible," says Dr. Sinha. "We know from experience that's minimally invasive surgery. Technology is here to stay, and robotics will be a big part of what we do as surgeons in the future. I have no doubt about that."