Sarah Bird during a follow-up visit with Hyunsuk Suh, MD.
Sarah Bird, a 27-year-old accounting supervisor, had a “very rough” month about a year ago. She went to Mount Sinai Union Square to check out a lump on her neck that she had first spotted in a photograph. During follow-up visits, an ultrasound scan and biopsy of her thyroid found a nodule the size of a golf ball, and she was advised to have it removed.
“I went from not even knowing I had this condition to being told, ‘You have to have surgery pretty quickly,’” she says.
Ms. Bird was worried about a long recuperation after surgery. And because she is fair-skinned and prone to thick, raised keloid scars, she also worried that she would have “this huge worm across my throat for the rest of my life.”
But those fears were put to rest by Hyunsuk Suh, MD, who used an advanced robotic procedure to remove the nodule. Ms. Bird says she is “just so thankful” that she was referred to Dr. Suh, Assistant Professor of Surgery at the Icahn School of Medicine at Mount Sinai, who in 2015 was the first in the United States to perform robotic bilateral axillo-breast approach (BABA), a “scarless” technique in which part or all of the thyroid is removed through four small incisions to the breasts and axilla (underarms). Mount Sinai is still one of only a few health systems in the nation to perform the procedure.
Dr. Suh also was the first in the nation to use robotic BABA to perform a radical modified neck dissection—removing a patient’s metastatic thyroid cancer and neck lymph nodes. Radical modified neck dissection typically requires an incision of about 10 centimeters, but the BABA technique uses four very small incisions, from 8 to 12 millimeters, making it unique among thyroidectomy approaches.
Dr. Suh, who earned his medical degree at the Johns Hopkins School of Medicine, trained with the physicians who developed the BABA procedure at Seoul National University in South Korea. When that six-month fellowship ended in 2015, he came to the Mount Sinai Health System, where he works closely with his mentor William B. Inabnet III, MD, Chair of Surgery, Mount Sinai Beth Israel, and Professor of Surgery, Icahn School of Medicine at Mount Sinai.
Robotic surgery is common in other specialties, such as urology and gynecology, Dr. Suh says, but it is an innovation in his field. “As surgeons we take great joy in learning new skills, new approaches, and new techniques,” he says, “and being in a place like Mount Sinai where there is an abundance of research and interests and innovations—that is very special.”
The BABA technique is as safe and effective as conventional thyroid surgery, Dr. Suh says, but some patients still prefer conventional surgery, which is typically performed through the front of the neck.
“Some people are apprehensive and fearful of something that is new. That is a natural response,” Dr. Suh says.“You have to explain to the patient how you were trained, and what the surgery entails, and what it means to do robotic surgery. Some people think you push a button and a robot comes out of a closet!”
Hyunsuk Suh, MD, was first in the nation to perform the advanced robotic procedure known as BABA.
Thyroid surgery—whether conventional or robotic—is usually ambulatory, meaning that patients are discharged after a few hours of observation. So Dr. Suh calls patients at home for a few days to check in. “Otherwise,” he says, “it is possible to lose the connection to the patient—being able to follow up on their symptoms and listen to their concerns.”
During Ms. Bird’s surgery, in March 2017, Dr. Suh removed the left lobe of the thyroid, including a benign four-centimeter nodule. Ms. Bird went home that day, and Dr. Suh called soon after.
“That was great,” she says. “I’ve never had a doctor who calls you at home and asks you how you’re doing.”
After some initial hoarseness and pain, Ms. Bird recovered quickly and was left with scars in her armpits that she says are “pretty much nonexistent.” In April 2017, she ran the SHAPE Women’s Half Marathon in 2 hours, 24 minutes. “It was my slowest half marathon ever,” Ms. Bird says. “But at least I finished, and it was very cool to be able to say, ‘You know, I had surgery a month ago, and I was down and out for a week, and now here I am crossing the finish line.’”