January 23, 2020 by John Fernandez
Her Skin Condition Called for ‘Scarless’ Parathyroid Surgery, A First in Florida
About two years ago, Lynette Boodhoo was told by her endocrinologist that he needed to monitor her hyperparathyroidism. But this past January, Mrs. Boodhoo was referred to Robert Udelsman, M.D., MBA, chief of Endocrine Surgery and director of the Endocrine Neoplasia Institute at Miami Cancer Institute.
She would need surgery to remove one of her parathyroid glands, which are right behind the thyroid gland in the neck.
(Watch now: The Baptist Health News Team hears from patient Lynette Boodhoo and Robert Udelsman, M.D., MBA, chief of Endocrine Surgery and director of the Endocrine Neoplasia Institute at Miami Cancer Institute. Video by Steve Pipho.)
Dr. Udelsman is the first physician in the U.S. to be fully trained in a new surgical technique that does not leave a visible scar on patients with certain benign and cancerous thyroid and parathyroid conditions. Unlike traditional thyroid or parathyroid surgery, which involves about a two-inch incision in the neck, a surgeon accesses the thyroid or parathyroid glands located on top of the windpipe through the inside of the lower lip.
Mrs. Boodhoo suffers from the skin condition vitiligo, which results in loss of skin color in the form of depigmented, or white, patches of skin. She sought Dr. Udelsman’s expertise in scarless techniques because traditional parathyroid surgery would make a neck scar even more visible than normal because of her vitiligo.
“Every time I get a deep cut, depigmentation occurs on my skin,” explains Mrs. Boodhoo. “So this is 100 percent why I wanted the surgery done this way.”
Dr. Udelsman recently performed Florida’s first trans-oral parathyroidectomy, or the removal of the parathyroid glands with no external scarring, on Mrs. Boodhoo. Last year, he performed the state’s first trans-oral thyroidectomy on another patient at Miami Cancer Institute.
In the trans-oral parathyroidectomy that Mrs. Boodhoo underwent, the parathyroid gland is accessed through three small incisions inside the lower lip. Through these incisions, small laparoscopic instruments are passed under the skin and down to the thyroid or parathyroid, as was the case with Mrs. Boodhoo.
“The operation is performed on a video screen using laparoscopic instruments — in this case pediatric instruments because the incisions are so small,” explains Dr. Udelsman. “We find the tumor and we take it out. We protect the structures next to it, including the nerves for the vocal cords.”
Mrs. Boodhoo said her surgery went very well and she was able to have breakfast the next morning.
“Besides having many skills, Dr. Udelsman is just a kind and compassionate person and he listens to you,” she says. “My advice to anyone who wants to consider this surgery is to have a consult with Dr. Udelsman.”
Dr. Udelsman said the success of Mrs. Boodhoo’s case and others could transform trans-oral parathyroidectomies and trans-oral thyroidectomies into “more common procedures in select institutions.
“I don’t want to tell you that this is an easy operation,” he adds. “It’s more difficult than the standard approach. So you have to ask the question: Should we be doing this procedure purely for a cosmetic reason? I would answer that by saying — look what people do for cosmetic approaches for many other operations. For a subset of patients … there are valid reasons to do it.”