Cervicoscopic Coblation Thyroid Surgery

Abstract

Objective: 1) To evaluate the efficacy and safety of cervicoscopic and coblation assisted surgery (CCAS) of thyroid. 2) To present a rare case of myofibroblastic nodule with focal embryonal tissue in a 72-year-old woman. 3) To understand these rare presentations for effective management.

Method: To evaluate the safety and efficacy of outcomes CCAS and conventional thyroid surgical procedures from October 2008 to September 2010. Arthrocare EVac 70 Xtra Plasma Wand was used for hemostasis and subcapsular dissection.

Results: One representative case includes a 72-year-old Afro-Caribbean woman who presented with 3-year history of progressive exertional dyspnea and hoarse voice due to diffuse multinodular goiter with a dominant solid nodule on ultrasound and a thy2 on needle aspirate. She was refused general anaesthesia. CCAS of thyroid under cervical block as a day case, revealed moth-eaten appearance thyroid follicles with areas of hemorrhage and cholesterol clefts with focal embryonal thyroid tissue and a prominent myofibroblastic nodule formation. In contrast the third patient in this series showed areas of fibrotic hemorrhagic nodules with cystic degeneration.

Conclusion: This study illustrates that CCAS of thyroid provides a minimally invasive technique with less morbidity and has good cosmetic outcome and is amenable to be performed under cervical block in selected patients. Myofibroblastic proliferation commonly reported in papillary carcinoma was contrary to association with benign pathology in this case.