Surgery for Thyroid Cancer

Thyroid Cancer Surgery : Cancer involving the thyroid gland is more commonly encountered in women than men. Thyroid Cancers are predominantly indolent with good long term survival.  However, there are vital structures close to the thyroid gland like the parathyroid glands which control the calcium metabolism in the body as well as the nerve which controls the voice box. Thus thyroid cancer surgery requires experience and high volumes such that patients do not suffer from lifelong sequalae of inadequate and inappropriate management. The team in the clinic with over 20 years of cumulative experience and a volume of approximately 30 thyroid surgeries / year of thyroid surgeries have a complication rate of less than 5% matching centres of excellence.

As with other cancers, thyroid cancer treatment is truly multidisciplinary. The surgeons work in tandem with a nuclear medicine specialist and an endocrinologist to give the best possible care to their patients.

 

Dr. Mitali Dandekar Lall has publications on thyroid cancer surgery which can be accessed by the following links:

 

  1. Priya SR, Dravid CS, Digumarti R, Dandekar M. Targeted Therapy for Medullary Thyroid Cancer: A Review. Front Oncol. 2017;7:238.

 

  1. Chaukar DA, Deshmukh AD, Dandekar MR. Management of thyroid cancers. Indian J Surg Oncol. 2010;1(2):151-162.

 

 

  1. Dandekar M, Kannan S, D’Cruz A. The thyroid and parathyroids. In: Lumley JSP, D’Cruz AK, Hoballah JJ, Scott- Connor CEH (editors) In: Hamilton Bailey’s Demonstrations of Physical Signs in Clinical Surgery, 19th CRC Press, Boca Raton, 2016,p410.

 

Surgery for voice box ( Larynx and hypopharynx) Cancer

Voice Surgery: Cancer involving the voice box and the adjacent pharynx ( gullet/throat) is predominantly seen in people consuming tobacco ( either chewed or smoked) and /or alcohol.  When the cancer is in the early stage ( Stage I/II), either surgery or radiotherapy is the treatment each with its pros and cons. Cancer surgery on the voice box involves performing a voice surgery to ensure minimal affection of the voice quality but at the same time ensure complete removal of the cancer. When the cancer involves the framework of the voice box,  complete removal of the voice box is the mainstay of treatment. Voice rehabilitation is done by using prosthetic voice. The team in the clinic is a fine combination of a head neck surgical oncologist as well as a minimally invasive surgeon proficient in voice surgery trained with stalwarts in the field.

Since cancer treatment is a team based approach, these doctors avail the services of experienced plastic surgeon, pathologist, medical and radiation oncologist.

 

Dr. Mitali Dandekar Lall has a publication related to cancer of the voice box which are not treated by voice surgery . It can be accessed by the following link:

 

Dandekar M, D’Cruz A. Organ preservation strategies: Review of literature and their applicability in developing nations. South Asian J Cancer 2014; 3(3):147-150.

Microlaryngeal Surgery

The voice box is formed by a complex assembly of very fine structures,the composite synchronisation of which produces flawless voice. Any type of voice surgery therefore shoud aim at restoring this synchronisation of the elements required for voicing. The vocal cords are subjected to relentless trauma by voice abuse or addictions like smoking.

Maxillectomy

Cancers of the sinus is relatively rare. Management of these cancers requires complete surgical removal with appropriate reconstruction followed by adjuvant radiotherapy with or without chemotherapy according to the pathological staging of the disease.Since surgery over the sinus can be potentially mutilating, there has been an advent in endoscopic approaches. The team in the clinic is a fine combination of a head neck surgical oncologist as well as a minimally invasive surgeon proficient in endoscopic apporaches for sinus surgery trained with stalwarts in the field of advanced endoscopic approaches of tumour extirpation. Additionally, such complex surgeries are performed with a neurosurgeon when the tumours involve the skull base. Since cancer treatment is a team based approach, these doctors avail the services of experienced plastic surgeon, pathologist, medical and radiation oncologist.

 

Dr. Abhineet Lall has a publication related to sinus surgery on unilateral maxillary ( sinus) swelling which can be accessed by the following link:

 

Patel H, Lall A. Unilateral Maxillary Swelling: A Retrospective Study. Indian J Otolaryngol Head Neck Surg. 2010; 62(4):403-407.

Endoscopic CSF Repair

Cerebrospinal fluid ( CSF) is present in the brain which is protected by the skull bones. Occasionally, due to bone thinning, infection, birth defects or trauma the bony protection is lost and the fluid leaks through the nose ( since the nose is just below the brain). This causes watery fluid to flow from the nose. This may at times result into threatening meningitis. This condition is corrected by surgery. Traditionally, this surgery was performed by opening the skull and repairing it causing significant post operative complications. Now, the same surgery can be performed by a minimal approach through the sinus ( sinus surgery).

Dr. Abhineet Lall with his robust training at the premier Seth GS Medical College and KEM Hospital followed  by  Fellowship for endoscopic surgery at Centres of excellence in the country and abroad ( Germany ) ensures he gives the best to his patients. The doctors work as a team with a neurosurgeon to ensure comprehensive care for the patients.

Endoscopic Resection of Tumour

Cancers of the sinus is relatively rare. Management of these cancers requires complete surgical removal with appropriate reconstruction followed by adjuvant radiotherapy with or without chemotherapy according to the pathological staging of the disease.Since surgery over the sinus can be potentially mutilating, there has been an advent in endoscopic approaches. The team in the clinic is a fine combination of a head neck surgical oncologist as well as a minimally invasive surgeon proficient in endoscopic apporaches for sinus surgery trained with stalwarts in the field of advanced endoscopic approaches of tumour extirpation. Additionally, such complex surgeries are performed with a neurosurgeon when the tumours involve the skull base. Since cancer treatment is a team based approach, these doctors avail the services of experienced plastic surgeon, pathologist, medical and radiation oncologist.

 

Dr. Abhineet Lall has a publication related to sinus surgery on unilateral maxillary ( sinus) swelling which can be accessed by the following link:

 

Patel H, Lall A. Unilateral Maxillary Swelling: A Retrospective Study. Indian J Otolaryngol Head Neck Surg. 2010; 62(4):403-407.

Temporal Bone Resection

Surgery for Hearing

Ear cancer is a rare cancer affecting the ear canal as well as the bones of the ear ( ie temporal bone surgery). Surgical extirpation is the treatment of choice followed by appropriate reconstruction. Following this, either adjuvant radiotherapy or chemoradiotherapy  is resorted to depending upon pathological staging.

The team of doctors in the clinic are trained and experienced in performing such complex skull base surgeries. The unique combination of a head neck surgical oncologist and a neuro otologist and skull base surgeon enable this team to give the best to their patients in terms of  ear surgery with oncological safety as well as functional outcomes with surgery for hearing as deemed suitable.  Since cancer treatment is a team based approach, these doctors avail the services of experienced plastic surgeon, pathologist, medical and radiation oncologist.

Subtotal Petrosectomy

Surgery for Hearing

Ear infections occasionally can get notorious and erode the bones of the ear ( temporal bone). If left unattended, it can progress to pus formation in adjacent areas like the brain and neck. Occasionally, this becomes life threatening. Whether it is aggressive ear infection, cholesteatoma or cancer of ear in this region, the treatment is ear surgery encompassing removal of the affected area. Surgery for hearing is generally not considered in this scenario since the principal aim is complete extirpation of disease. However, individualisation of every patients disease is essential before decision making.

Facial Nerve Decompression

Surgery for Hearing

The facial nerve is responsible for controlling the expressions of the face. There is one nerve on either side of the face. In the ear, it is placed in a very narrow canal to protect it. However, sometimes the facial nerve may undergo swelling within the canal due to infection or trauma. Since the canal is narrow, it does not allow adequate space for the swollen nerve to expand. This causes dysfunction of the nerve resulting into facial paralysis. The treatment for this is ear surgery to decompress the nerve. It is a surgery which requires astute clinical judgement with controlled handling of the nerve to ensure complete recovery. Dr. Abhineet Lall with his robust training at the premier Seth GS Medical College and KEM Hospital followed  by Otology Fellowships at Centres of excellence in the country and abroad ensures he gives the best to his patients.

Myringotomy with Grommet Insertion

Surgery for Hearing

The middle ear space undergoes pressure equalisation with the help of the eustachian tube ( ventilation tube). Many a times due to cold, infection etc. the eustachian tube is blocked. In children the eustachian tube is patulous and hence they are more prone to its blockage. This results into problems in the ear causing retraction of the drum, secretions to accumulate in the middle ear and hearing problems apart from earache and discomfort.

Myringotomy is a ear surgery by which a controlled, small performation is made in the ear drum at the appropriate location to aid the ear secretions to drain out. If the problem is of a chronic nature, then a ventilation tube ( grommet) is inserted which helps in pressure equalisation. This surgery for hearing prevents long term complications of a retracted eardrum like cholesteatoma formation.