# Robotic Surgery-Share Your Experiences



## questions

I had robotic thyroid surgery in December. My entire thyroid was removed via small scars under my armpits. The incisions are minor and the healing from the incisions was a breeze. However, I am six weeks post-op and am experiencing cramping in toes/feet and numbness/pulling sensation in the neck area. I have not tried massage therapy for the pulling/tightness in the neck. Three weeks post-operative I was hyperthyroid and my Synthroid was reduced from .125 to .112. I am currently taking Slow Fe and Wellesse Calcium/D3 to combat anemia and calcium deficiencies. The surgery went well, but I had major challenges due to aspiration from anesthesia, and my acid reflux seems worse. Are there other thyroid robotic patients out there who can share their experiences and offer post-surgical advice to support others like me?


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## lavender

I had traditional through the neck thyroid removal so I can not say much about your surgery in particular. I'm a bit intrigued because I liked the idea of going with a procedure my surgeon had been practicing for years as opposed to something brand new. With the faster healing, I can see why someone might choose the robotic surgery.

The toe cramping makes me think of low calcium. You mention that you are taking calcium supplements. I looked up the brand you mentioned, and I am a bit skepticle of it's effectiveness. My parathyroids were damaged, and I was told to take Citracal by my surgeon and endo because it contains Calcium Citrate, which is the most easily absorbed form of calcium. I tried a generic at one point, and it was worthless. The Wellesse you mention has Clacium citrate, but it also contains Tricalcium phosphate, which according to Wikipedia is not easily absorbed. The web site of Wellesse does not say what proportion of Calcium Citrate vs Tricalcium phosphate, so it's impossible to how much Calcium your body is actually absorbing. 
http://en.wikipedia.org/wiki/Tricalcium_phosphate

Are you getting blood tests to check your calcium and parathyroid levels? What about Vitamin D and Iron since you are supplementing them as well. Also, I found that I have to take magnesium daily for the calcium and D to work. I found magnesium makes a huge difference in my low calcium symptoms.

Massage has helped my neck a lot. Both professional massage, and me just rubbing my scar all the time. There's a lot to heal on the inside even if the outside looks fine.

As far as the numbness, any chance there was nerve damage?


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## questions

Thanks for your advice. I will try Citrical. I will have follow-up blood work done next week for anemia and calcium. . What type/brand of magnesium do you take? In two weeks I am scheduled for blood work to check thyroid levels. Had I not had complications with anesthesia, the recovery would have been faster. However, I have a feeling that the pulling/numbness might be due to the "tunneling" from the armpit to get to the thyroid. I have been told that it takes time, but I am also in search of ways to assist the healing process.


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## Andros

questions said:


> I had robotic thyroid surgery in December. My entire thyroid was removed via small scars under my armpits. The incisions are minor and the healing from the incisions was a breeze. However, I am six weeks post-op and am experiencing cramping in toes/feet and numbness/pulling sensation in the neck area. I have not tried massage therapy for the pulling/tightness in the neck. Three weeks post-operative I was hyperthyroid and my Synthroid was reduced from .125 to .112. I am currently taking Slow Fe and Wellesse Calcium/D3 to combat anemia and calcium deficiencies. The surgery went well, but I had major challenges due to aspiration from anesthesia, and my acid reflux seems worse. Are there other thyroid robotic patients out there who can share their experiences and offer post-surgical advice to support others like me?


Goodness! I am sorry to hear of the problems. I think we have a few contemplating this type of surgery but I don't think we have anyone here who has.

I think you could be very helpful to several by sharing your expience though.

Welcome!


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## lavender

I take Reacted Magnesium from Ortho Molecular Products. They have a website you can order directly from.

Tunneling sounds ouchy. But I suppose having my neck sliced open was ouchy too.

I don't think I have seen anyone on this board who has gone for the armpit route, but there are a couple people pursuing non-neck approaches. You are one brave pioneer! The local university announced that they did their first armpit surgery weeks before I had mine at another hospital. I was so not willing to be one of their first patients!


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## questions

Andros said:


> Goodness! I am sorry to hear of the problems. I think we have a few contemplating this type of surgery but I don't think we have anyone here who has.
> 
> I think you could be very helpful to several by sharing your expience though.
> 
> Welcome!


Here is my experience so far. If there are any other robotic patients out there, please share! I chose robotic thyroidectomy for several reasons. I develop keloids easily and do not have folds in the neck that could hide such scars should they appear after surgery. I also wanted to get back to work quickly. The biggest factor, however, was that my insurance covered the use of the robot. While your insurance may cover thyroidectomy, it may not include the cost of the robot, which would have been $14,000 out-of-pocket at MD Anderson.

*What to look for in a surgeon who performs robotic thyroidectomy:*
1. Honesty--my surgeon told me about the numb, squishy feeling I would have in the upper chest area near my collar bone. She was open about the number of robotic surgeries she previously performed, as well as her training. The surgery took five hours to complete.
2. A team effort--look for a surgeon who works in the operating room with a regular "robotic" team: nurse, assistants, anesthesiologist, etc. During part of the surgery, the surgeon is at the computer (away from the operating table) directing the robotic arms. The team is near the patient. You will also want to know that the office staff (physician's assistant, clinical nurse, etc.) are very familiar with the procedure so that they can field your post-surgical questions. Look for a surgical team that trained under experienced robotic surgeons, such as the Davinci thyroidectomy inventor from Korea.
3. Ask if the surgeon has a background in endocrinology. This will help with your post-operative medication and ease the transition back to your regular primary care doctor or endocrinologist.

*Other things to consider:*
1. Educate your family--I learned that I have many of the same post-surgical concerns as do patients who undergo traditional thyroidectomies (regulating hormones, strange sensations in the neck area, difficulty swallowing, calcium deficiencies, etc.). You will need just as much care at home, especially since you will be tender under the arms if you opt for the armpit incisions. Google robotic thyroidectomy and watch some of the videos (Dr. Kuppersmith has some good ones) with your family so that they will understand how the surgeon first tunnels a path from the upper armpit to the gland. My surgeon opted for an incision under each arm--one incision to remove one lobe and the other to remove the isthmus and the second lobe. Remember that hospital-sponsored patient testimonies make the procedure seem simple and relatively painless, as if you can undergo post-op alone. I recommend that you treat your robotic post-op care as you would traditional post-op care. The only difference is the location of the scar. Take it easy and heal. My surgeon's advice is to "listen to your body."
2. While the surgery is typically considered a 23-hour one, get your surgeon's insurance verifiers to preapprove longer than 23 hours in case complications arise. This proved helpful in my case since pulmonary aspiration occurred.
3. Every doctor is different. Mine prefers not to do the "armpit" robotic route for patients who are very muscular in the neck, shoulder, and chest area. She also uses the robotic method for removing thyroids that do not appear cancerous. 
4. The under-the-arm incision requires that your arms are placed above your head during the entire surgery. My surgeon allows patients to comfortably position their arms prior to being put to sleep to lessen the possibility of pain in the shoulders after surgery.
5. Drains--under each arm. I had what looked like tiny clear hot water bottles for drains. They were painless and were removed in three days. I did not have sutures; instead I had the "sticky tape" (forget the real name) over the incisions. They were painlessly removed about three weeks post-op.

My thyroidectomy was successful. I was able to eat the first day that I recovered from the aspiration incident. However, by the third day, swallowing became more difficult, and by the third week, the pulling and tightness began in the neck area. I was told that this was normal as nerves and tissue heals. Remember, though, that my post-op experience was different from many because I suffered from coughing and breathing difficulties, as well as acid reflux. After surgery, I was on a ventilator for a while, so the extended intubation probably didn't help matters. The aspiration is a risk with any surgery; know whether you are at high risk for such a mishap, especially since the robotic surgery may require a longer period of general anesthesia.


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## questions

Lavendar,
I don't know about being "brave." I was actually afraid of the traditional "ouch." Thanks for sharing.


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## Lovlkn

questions,

Go have a massage therapist work on your neck and it will most likely break adhesion's and loosen everything up. Mine stuck her fingers so deep into the site I thought she would bust it open but it did the trick of taking away that pulling sensation. Six years post op the incision site does not bother me at all so I give full credit to the early adhesion release.

I had minimally invasive technique 6 years ago to remove my thyroid -90 minutes of surgery. I was eating the next day as well and even cooked dinner for my family the day I came home No drains were placed and I was off pain medications within 2 days.

My neck incision is less than 1" and nobody ever notices it.

Glad you are happy with your outcome.

I would agree that you should have your calcium levels checked due to the numbness.


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## lavender

I have had a massage therapist work on my neck after traditional surgery and it has been super helpful. I was in surgery for 3-4 hours. Not sure why it took so long. I figure that keeping my body contorted in a strange position to expose my neck that long had an effect on my muscles even if I was asleep. I have fibromyalgia, and my worst post-op pain was in my neck, shoulders and back, not the actual incision. Seems like this could be the case for robotic surgery since it takes a lot longer.


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