UCSF Fresno Surgeons Perform Thyroid Surgery with No Tell-Tale Scar

Rita Locke of Coalinga had taken thyroid medication for eight years but this past winter a nodule had grown so large that at night she had to change sleeping positions to swallow.

She needed thyroid surgery and she expected an operation would leave a tell-tale scar in the middle of her neck, a lasting reminder she reluctantly was prepared to accept.

But Locke was pleasantly surprised when UCSF Fresno endocrine surgeon Farah Karipineni, MD, MPH, said she was a good candidate for a scarless thyroid surgery. The technique – known as transoral endoscopic thyroidectomy vestibular approach (TOETVA) – has good outcomes – and with the added cosmetic benefit of no scar.

Dr. Karipineni is the first surgeon in the central San Joaquin Valley to perform TOETVA. The procedure involves making small incisions inside the lip instead of at the neck to reach the thyroid gland, a small butterfly-shaped gland that produces hormones to regulate body metabolism.

Dr. Karipineni began performing scarless thyroid surgeries in Fresno last year. Before that, patients in the San Joaquin Valley had to travel to the UC San Francisco or go to the East Coast and Florida for the procedure.

Locke, 63, had a swift recovery after her surgery on Dec. 13. She spent a night in the hospital (but only as a precaution because of the travel distance to her home in Coalinga). The day after surgery she was eating normal food. “No complications,” she said. “The worst I needed is some Tylenol … when I chewed too much and something kind of irritated the spot.”

While Locke had little pain, the scarless surgery is not pain-free, Dr. Karipineni said. “It’s impossible to do surgery that has no consequences,” she said.

And TOETVA is not for every patient. The surgery is best suited for patients who are not obese and who have small nodules, less than six centimeters. It’s also best if there is no inflammation of the thyroid and no scar tissue from a previous surgery in the area, Dr. Karipineni said.

UCSF Fresno’s Christina Maser, MD, FACS, an endocrine surgeon who brought minimally invasive parathyroid surgery to Fresno and helped recruit Dr. Karipineni, also is now performing scarless thyroid surgeries. She sees benefits for patients. “Even if a patient feels that they’re going to be OK with a scar sometimes there’s a little more psychological consequence than anyone anticipates, including the patients themselves,” she said.

Most thyroid surgery patients seem unconcerned about a scar, Dr. Karipineni agreed. But some patients could have issues that they are reluctant to express, she said. “They’re ashamed to mention that they’re worried about it so it’s almost like they’re trying to hide that they’re worried.”

Locke said she just wanted the best outcome from thyroid surgery, and is pleased with the removal of the nodule. But not having a scar on her neck has been a bonus.

“I’ve just been blessed that God matched me up with Dr. Karipineni,” she said. “It’s been a great experience.”