Mount Sinai Surgeons Remove Thyroid Gland Through Hidden Incision Underneath the Lip

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A team of surgeons at Mount Sinai Beth Israel have performed the first endoscopic transoral thyroidectomy in New York, and one of the first of its kind in the nation.

William B. Inabnet III, MD, leads a team of surgeons during an endoscopic transoral thyroidectomy.

We now have the ability to approach the thyroid gland from below, from the side, or from above through the mouth.

A team of surgeons at Mount Sinai Beth Israel (MSBI), led by William B. Inabnet III, MD, the Eugene W. Friedman, MD, Professor of Surgery and Chair for the Department of Surgery at MSBI and Chief of Endocrine Surgery Quality for the Mount Sinai Health System, have performed the first endoscopic transoral thyroidectomy in New York, and one of the first of its kind in the nation. Their initial case, which is the first published report in the United States, was recently described in the journal Surgical Endoscopy.

With the assistance of Gustavo Fernandez-Ranvier, MD, and Hyunsuk Suh, MD, both Assistant Professors in the Department of Surgery at the Icahn School of Medicine at Mount Sinai, Dr. Inabnet removed the thyroid gland by making three small incisions inside the mouth underneath the lower lip. He inserted ports through the incisions, including an endoscope – a medical device with a light and camera. Once a working space within the neck area was created, Dr. Inabnet preserved the critical structures and removed the thyroid gland through the largest of the incisions. This minimally-invasive procedure leaves a hidden scar compared to the conventional transcervical approach, which leaves a visible scar on the patient’s neck.

“Out of all of the approaches, this is the one type of thyroid operation where there is no sign that the patient underwent surgery,” said Dr. Inabnet. “This procedure is best equipped for smaller nodules and early-stage papillary thyroid cancer. I anticipate it will evolve for other applications going forward.”

Dr. Inabnet and his team specialize in a group of operations known as hidden-scar endoscopic thyroid surgery, which includes the transaxillary approach where incisions are made under the armpit, and the bilateral axillary breast approach, also known as BABA, where four small incisions are made in hidden locations on the chest.

“The transoral route is a natural addition to our growing program of minimally invasive techniques,” said Dr. Inabnet. “We now have the ability to approach the thyroid gland from below, from the side, or from above through the mouth.”

Dr. Inabnet has pioneered new techniques in minimally invasive endocrine neck surgery as well as adrenal and pancreatic surgery. In 1998, he helped perform the first endoscopic thyroid resection in the United States (the second in the world) and has advanced the field of video-endoscopic neck surgery.

About the Mount Sinai Health System
The Mount Sinai Health System is an integrated health system committed to providing distinguished care, conducting transformative research, and advancing biomedical education. Structured around seven hospital campuses and a single medical school, the Health System has an extensive ambulatory network and a range of inpatient and outpatient services—from community-based facilities to tertiary and quaternary care.

The System includes approximately 7,100 primary and specialty care physicians; 12 joint-venture ambulatory surgery centers; more than 140 ambulatory practices throughout the five boroughs of New York City, Westchester, Long Island, and Florida; and 31 affiliated community health centers. Physicians are affiliated with the renowned Icahn School of Medicine at Mount Sinai, which is ranked among the highest in the nation in National Institutes of Health funding per investigator. The Mount Sinai Hospital is in the “Honor Roll” of best hospitals in America, ranked No. 15 nationally in the 2016-2017 “Best Hospitals” issue of U.S. News & World Report. The Mount Sinai Hospital is also ranked as one of the nation’s top 20 hospitals in Geriatrics, Gastroenterology/GI Surgery, Cardiology/Heart Surgery, Diabetes/Endocrinology, Nephrology, Neurology/Neurosurgery, and Ear, Nose & Throat, and is in the top 50 in four other specialties. New York Eye and Ear Infirmary of Mount Sinai is ranked No. 10 nationally for Ophthalmology, while Mount Sinai Beth Israel, Mount Sinai St. Luke's, and Mount Sinai West are ranked regionally. Mount Sinai’s Kravis Children’s Hospital is ranked in seven out of ten pediatric specialties by U.S. News & World Report in "Best Children's Hospitals."

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Matt Kozar
The Mount Sinai Health System
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