Elizabeth Klein is used to the spotlight, but there was something the budding actress from Bethesda didn't want everyone to see.

That was a telltale mark on her throat from thyroid surgery.


"I don't want every character I play to have the same scar," said Klein, who had a thyroidectomy on Jan. 10. "It's a very obvious scar."

But Klein doesn't have a scar, at least not a visible one, anymore. Her doctors at Johns Hopkins Hospital have recently begun offering a "facelift" style procedure that hides evidence of surgery behind her ear and under her hair.

The surgery employs a robot arm to remove the thyroid through a tunnel made from the side of the neck. It was developed a few years ago, is offered at fewer than half a dozen hospitals and is still used sparingly. It expands on the work of a South Korean doctor who began removing thyroids through the armpit on women who refused to have a two- or three-inch scar on their necks.

From her home in New York, where she's in graduate school for acting, Klein and her mother searched for a doctor who could do the procedure and chose Dr. Jeremy D. Richmon, a Hopkins head and neck surgeon.

In the early hours on surgery day this month, Richmon and a fellow surgeon, Dr. Jason Prescott, explained to Klein how they would cut through the soft tissue in her neck from behind her left ear, careful to avoid nerves and her vocal cords, to remove half her thyroid, the left lobe. A nodule had grown to about three-quarters the size of that lobe, and would continue to expand.

There was a small chance that the nodule was cancerous, and the only way to be sure was to remove it and send it to a lab for testing.

The thyroid is a butterfly-shaped gland flanking the trachea that helps regulate the body's metabolism. Without a thyroid, people need to take hormone replacements to help their bodies use energy, stay warm and keep muscles and organs functioning properly.

Nodules, or lumps, on the gland are much more common on women. Doctors say images would show nodules on perhaps 5 percent to 10 percent of all women, and 60 percent of older women, though the bulk is not cancer.

The American Cancer Society reports there are about 60,220 new cases of thyroid cancer a year. Many nodules, however, are suspicious, and because biopsies don't reliably detect the disease on large ones, there are up to 150,000 surgeries to remove them a year.

Some women are comfortable showing their scars, such as "Dancing With the Stars" host Brooke Burke-Charvet, who recently displayed hers on a talk show. But Richmon said not everyone wants to go on television to show off their surgery.

"Only real benefit is the avoidance of a visible scar," said Richmon about the new surgery. "It's not something we're pushing patients to have. This is for patients who are reluctant to have surgery because they don't want a neck scar."

Richmon and Prescott started the 21/2 -hour surgery at about 8 a.m., anesthetizing Klein and draping her and their equipment with blue sterile wraps. They shaved a small amount of her hair and began cutting.

The doctors were joined by seven other clinicians, including an anesthesiology staff, operating room nurses, a surgery fellow and a surgery tech – a few more than needed in traditional surgery because the procedure is still so new. It has only been performed about 15 times at Hopkins.

Once the incision is made, the doctors fold back a flap of skin and begin tunneling through the soft tissue of the neck. After about an hour and a half of dodging nerves and cutting flesh, they brought in the da Vinci robot, with its precise instruments for removing the lobe.


"This is not minimally invasive," said Prescott, unlike other robot surgeries. There aren't yet precision tools for the job; those used were meant for prostates and colons. But doctors plan to work with Hopkins engineers to create the equipment.

Richmon mans the robot controls, which look a bit like a race car video game. He gets a crisp 3-D view that also displays on several monitors around the operating room.

He learned how to do the procedure from Dr. David Terris, a surgeon and co-director of the Georgia Regents Medical Center Thyroid/Parathyroid Center. Terris developed the procedure when complications began arising in 2009 after thyroidectomies performed through the armpit.

Terris has performed the surgery about 60 times but cautions that it's not for everyone.

He said only one-half of the thyroid can be removed this way at a time, which works for patients with nodules on one side. Occasionally he'll perform the procedure twice to cut out both lobes. The nodules also are typically small, no more than three centimeters, because they are pulled through the tunnel created in the neck.

Terris doesn't like to use the procedure when he knows patients have cancer because they need their entire thyroid removed.

And, he said, "if you care about an easier and faster recovery, go for the scar."

He also said, "For me, being able to offer this procedure is quite satisfying. A lot of young women have anxiety about having a scar from thyroid surgery, and when they discover we can do it without a scar, they are relieved."

Klein said that if she needs the other half of her thyroid removed, she'll have the same procedure on her right side — she'll know in another week or so, when her test results are returned.

Days after the surgery she said she was still a bit sore, and expected to be so for another week or more. But she's in her last year in school and plans to spend the spring on stage, acting in plays produced for her and her classmates.

She's glad her audience will see her freckles and fair skin — and her characters — and not a patient.

"I'm 28 and don't want a scar for the rest of my life," she said. "People would always worry and always have questions."