Endoscopic Thyroidectomy

Park, Yong Lai; Shin, Jun Ho; Pae, Won Kil

Abstract

PURPOSE: Endoscopic surgery is becoming more widely used because of its low invasiveness and cosmetic effect. However reports on its use in thyroid surgery are scarce particularly with regard to exploiting the advantage of eliminating the unattractive scars that are sometimes encountered in con ventional operations on the exposed anterior part of the neck. Thus, we applied this to thyroidectomy.
METHODS
This clinical trial was conducted on a total of 29 patients hospitalized in our Department from December 1998 to August 1999. Our operation method was as follows. Three trochars were inserted, one at each circumareolar area on the breast (5 mm) and one in the skin between these (15 mm). Subplatysmal and subcutaneous operative space was created with CO2 insufflation at 6-7 mmHg from straight-line between two nipples to just below the thyroid gland. The thyroidal vessels and the parenchyma of the gland were dissected and divided using an ultrasonic scalpel and commonly used-laparoscopic instruments. RESULTS: The patients consisted of 25 females and 4 males. The anesthesia and operation time was 220 10.4 minutes and 165.7 9.4 minutes respectively. We had 4 cases of conversion to a conventional thyroidectomy because of uncontrolled intraoperative bleeding (1 case), technical failure (1 case) and thyroid carcinoma (2 cases). Postoperative complications occurred in 2 cases, injury of recurrent laryngeal nerve and severe anterior chest discomfort for 3 months. The average length of postoperative stay was 6.7 days. Operative scars were completely covered by clothes, and cosmetic results were excellent. CONCLUSION: With these results, the cosmetic effect may be regarded as the only strength of an endoscopic thyroidectomy but by going through more cases, this technique could be performed safely with the other advantages of endoscopic surgery such as shortened operation time and hospital stay, et al. We hope an endoscopic thyroidectomy will be another surgery of choice for most patients with thyroid disease.