Yonsei Med J.  2011 Jul;52(4):643-654. 10.3349/ymj.2011.52.4.643.

Endoscopic Thyroidectomy via an Axillo-Breast Approach without Gas Insufflation for Benign Thyroid Nodules and Micropapillary Carcinomas: Preliminary Results

• Hong HJ
• Kim WS
• Koh YW
• Lee SY
• Shin YS
• Koo YC
• Park YA
• Choi EC

• KMID: 1727998
• DOI: http://doi.org/10.3349/ymj.2011.52.4.643

Abstract

PURPOSE
To examine the feasibility of endoscopic thyroidectomy (ET) via an axillo-breast approach without gas insufflation for large thyroid tumors and micropapillary carcinomas.
MATERIALS AND METHODS
The patients in the benign group were separated into groups 1 (n=95, <4 cm in tumor diameter) and 2 (n=37, > or =4 cm in tumor diameter). Also, 57 patients in the micropapillary carcinoma group underwent an endoscopic hemithyroidectomy (HT) (group 3) and were compared with 60 patients who received conventional open HT (group 4). Postoperative functional outcome, local complications, surgical outcomes, and pathological outcomes were compared between the groups.
RESULTS
In the benign group, there was no significant difference in mean operating time, hospital stay, or overall perioperative complications between the two groups. In the micropapillary carcinoma group, mean operating time and hospital stay in group 3 were significantly longer than in group 4 (p=0.015 and p< or =0.001). The overall perioperative complications did not differ significantly between the groups. The postoperative cosmetic result was better in groups 1-3 (endo group) than in group 4 (open group).
CONCLUSION
ET via a gasless axillo-breast approach seems to be a safe procedure even for benign thyroid lesions > or =4 cm and micropapillary carcinomas. Although it has the advantage of better cosmetic results over open thyroidectomy, there is room for improvement in terms of lessening its invasiveness and shortening the operative time.

Keyword

Endoscopic thyroidectomy; thyroid cancer; thyroid tumor; vocal cord palsy; hypocalcaemia

MeSH Terms

Adult
Carcinoma, Papillary/pathology/*surgery
Endoscopy/adverse effects/methods
Female
Humans
Male
Middle Aged
Retrospective Studies
Thyroid Nodule/pathology/*surgery
Thyroidectomy/adverse effects/*methods
Treatment Outcome

Figure

• 

  Fig. 1 Axillo-breast approach. (A) A working space is created by inserting an external retractor (Sejong Medical Corporation) through the axillary skin incision. The periareolar skin incision is used for the placement of a 12-mm trocar. (B) The superior thyroid artery (left) is easily identified and sealed off using the harmonic scalpel. (C) The left superior parathyroid gland was identified and preserved between the recurrent laryngeal nerve and common carotid artery (CCA). (D) The left endoscopic hemithyroidectomy was completed.

• 

  Fig. 2 Surgical procedures for the unilateral axillo-breast approach. (A) The inferior thyroid artery was identified close to the recurrent laryngeal nerve. (B) Hemithyroidectomy with paratracheal lymph node dissection is performed with careful dissection of the recurrent laryngeal nerve. (C) The left hemithyroidectomy-specimen-en bloc with ipsilateral CND is shown. (D) A specimen of large goiter resected via hemithyroidectomy (HT). The surgical specimens showed that thyroidectomy was accomplished without violation of the thyroid capsule.

• 

  Fig. 3 Postoperative functional outcome [GRBAS scale, Voice Handicap Index (VHI)], easy fatigue during phonation, difficulty with high pitch and singing voice, hypoesthesia or paraesthesia in the neck or anterior chest wall, and swallowing difficulty were analyzed at postoperative months 1 (Post 1M) and 6 (Post 6M). * and ** Significant impairment compared to preoperative period (PreOP) (p<0.05). (A) Subjective parameters-open thyroidectomy group. (B) Subjective parameters-endoscopic thyroidectomy group.

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