First endoscopic neck surgery deemed a success

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David Terris, left, discusses the unprecedented endoscopic neck surgery with patient Martin Wargo, who said his recovery was "quick and pain-free."

First endoscopic neck surgery deemed a success

If you had to pick a location where you wouldn't want a three-inch scar, your neck would be high on the list. But until recently, a procedure leaving a visible scar was the only option available for people who needed surgery on their neck.

Now a Stanford researcher offers an alternative - endoscopic neck surgery, leaving only three tiny scars near the collarbone.

"This makes surgery more tolerable and provides a way to remove tissue without leaving a surgeon's signature behind," said David Terris, associate professor of surgery at the School of Medicine. "Anything we can do to minimize or hide a scar is doing patients a favor."

Endoscopy is commonly done for stomach and orthopedic surgery because it leads to less scarring and a faster healing time. Doctors have long searched for a way to perform endoscopic surgery on the neck - where prominent scars have in the past been unavoidable.

Experiments testing endoscopic neck surgery in pigs - which have an anatomy similar to humans - have left doctors less than hopeful. The major problem was caused by carbon dioxide bubbles leaking into the bloodstream where they act like blood clots and can cause strokes.

"The stomach has a big sac around it so there's no fear of the carbon dioxide gas escaping," Terris said. "There's no such sac in the neck, so we had to develop a way to create a pocket to work in without sending the gas elsewhere."

Terris and his team solved the problem by trying a hybrid technique. They inserted a balloon under the skin of the neck to create an opening, then blew gas into the opening at low pressure to hold the space open. Testing their strategy in pigs, no gas leaked into blood vessels and the operations went smoothly.

Terris then found the ideal first human patient in Martin Wargo. Wargo had an enlarged lymph node and needed it biopsied, but because of a previous medical procedure, he was on immune-suppressant drugs that slow the healing process and increase the risk of infections from major surgery. Endoscopic surgery would minimize those risks while giving him the care he needed.

Terris said the surgery took longer than normal, but Wargo was able to go home that night. His only sign of surgery is a half-inch scar and two quarter-inch scars near his collarbone. The scars are below the collar and are fully covered by ordinary clothing.

"He is doing fantastically well," Terris said.

"What surprised me is that it hadn't been done before," Wargo said. "These days everybody is getting endoscopes." He was able to sleep normally that night and could have worked the next day. "I felt no discomfort and the recovery was quick and pain-free."

Terris expects endoscopic neck surgery to be widely used. "I think this will be adoptable for removing many lumps and bumps," Terris said. He added that as other doctors see that the surgery is safe, they'll be able to use the technique for more major neck surgery.