Surgeons remove cancerous lymph nodes through hidden scar procedure

A team of surgeons at Mount Sinai Beth Israel, led by Hyunsuk Suh, MD, Assistant Professor in the Department of Surgery at the Icahn School of Medicine at Mount Sinai, have performed the first robot-assisted radical neck dissection in the United States using the bilateral axillo-breast approach (BABA), a surgery that involves removing all of the lymph nodes on one side of the neck. The results were published today in the journal VideoEndocrinology.

Dr. Suh and the endocrine surgery team at Mount Sinai are the only surgeons in the country currently utilizing the BABA technique to treat benign and malignant thyroid disorders. His current study explores the use of BABA to remove metastatic cancer in the lateral neck. In the published case, Dr. Suh performed surgery with the da Vinci© Surgical System and removed 59 lymph nodes from a female patient; two lymph nodes tested positive for cancer. This patient was diagnosed with thyroid cancer over a year ago and underwent a conventional thyroid surgery through the neck, but her cancer spread to the lymph nodes, requiring more extensive surgery. In an effort to avoid a significant neck scar, she opted for BABA.

The BABA technique entails the surgeon making two incisions along each areola and two incisions in the skin creases of the armpit. Robotic instruments, including an endoscope (a medical device with a light and camera), are then inserted into the incisions. Once a working space within the neck area is created, Dr. Suh preserves the critical structures before removing the diseased lymph nodes or thyroid gland. This minimally-invasive procedure leaves a hidden scar compared to the conventional approach where the surgeon makes an incision on the neck.

"This is the ideal procedure for patients who want to avoid a visible neck scar and maintain confidentiality," says Dr. Suh. "Following surgery, most patients can return home the same day."

Dr. Suh says the use of the robotic platform provides excellent visualization of anatomic structures, and the robotic instruments allow for maneuvers that are safer and more accurate. He's performed 40 robotic thyroidectomies at Mount Sinai Beth Israel. Dr. Suh studied the BABA approach at Seoul National University Hospital in South Korea where it was developed.

"Surgical innovations must entail safe and sound outcomes as well as added benefits to the patients. Robotic thyroidectomy is yet an FDA off-labelled procedure in the US, but through ongoing advancement and proper implementation, BABA technique will have the great impact in the field of thyroid surgery," says Dr. Suh.

"Dr Suh is one of our star recruits who brings a new skill set to our growing remote access thyroid surgery program", says Dr. William B Inabnet III, FACS, Chair of Surgery at Mount Sinai Beth Israel. Dr. Suh joined the Mount Sinai Endocrine Surgery Program, which has a long tradition of performing hidden-scar endoscopic thyroid surgery, including the transoral approach. That technique involves removing the thyroid gland by making three small incisions inside the mouth underneath the lower lip.