J Korean Med Assoc.  2007 Aug;50(8):736-742. 10.5124/jkma.2007.50.8.736.

Endoscopic Thyroidectomy

• Moon BI

• KMID: 2184902
• DOI: http://doi.org/10.5124/jkma.2007.50.8.736

Abstract

One of the problems of surgery in the neck is the scar. The rapid development of laparoscopic surgery in the 1990s led to the development of endoscopic techniques for surgery of the neck. With recent advancement of instruments such as electric endoscopy, ultrashears, and small endoscopic dissecting devices, cervical scarless endoscopic thyroidectomy is rapidly becoming a common approach in many institutions. Multiple endoscopic approaches for thyroid surgery have been developed, ranging from gasless, video-assisted approach to a complete endoscopic approaches such as cervical, axillary, axillo-bilateral breast and anterior chest approach. Although each method has its own advantages and disadvantages, all methods are technically feasible, safer, and cosmetically more excellent compared to conventional thyroidectomy. Operative time can be shortened according to the accumulation of surgeon's experience. Indication has been widened from small benign tumors to larger tumors and papillary microcarcinoma. Further studies for comparative evaluation of several methods and applying these methods to the malignant thyroid tumors are needed.

Keyword

Endoscopic thyroidectomy; Thyroid; Tumor

MeSH Terms

Breast
Cicatrix
Endoscopy
Laparoscopy
Neck
Operative Time
Thorax
Thyroid Gland
Thyroidectomy*

Figure

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  Figure 1 Endoscopic view of recurrent laryngeal nerve and infe-rior thyroid artery.

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  Figure 2 Port insertion in the cervical endoscopic thyroidectomy. (Moon, et al. 2002)

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  Figure 3 Schema of the anterior neck area from the axilla. The excoriated layer under platysma from the axilla is indicated by oblique lines. A 12-mm and a 5-mm trocar were inserted through the 30-mm skin incision in the axilla, and one more 5-mm trocar was inserted near the incision. (Ikeda, et al. 2000)

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  Figure 4 Bilateral axillo-breast approach (BABA). Two 12mm ports inserted via each circumareolar incisions and two 5mm ports via bilateral axillary incisions. The parts of the dotted line represent the anatomical landmarks and extent of dissection. (Choe, et al. 2007)

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  Figure 5 Gasless endoscopic thyroidectomy via anterior chest approach. (Kim, et al. 2001)

Reference

1. Gagner M. Endoscopic subtotal parathyroidectomy in patients with primary hyperparathyroidism (letter). Brit J Surg. 1996. 83:875.

2. Yeung HC, Ng WT, Kong CK. Endoscopic thyroid and parathyroid surgery. Surg Endosc. 1997. 11:1135.

3. Huscher CS, Chiodini S, Napolitano C, Recher A. Endoscopic right thyroid lobectomy. Surg Endosc. 1997. 11:877.

4. Kanauchi H, Yamasaki K, Ogawa T, Mimura Y. Endoscopic thyroidectomy in a porcine. Endocr J. 1998. 45:135–136.

5. Jones DB, Quasebarth MA, Brunt LM. Videoendoscopic thyroidectomy: experimental development of a new technique. Surg Laparosc Endosc Percutan Tech. 1999. 9:167–170.

6. Iacconi P, Bendinelli C, Miccoli P. Endoscopic thyroid and parathyroid surgery. Surg Endosc. 1999. 13:314–315.

7. Shimizu K, Akira S, Jasmi AY, Kitamura Y, Kitagawa W, Akasu H, Tanaka S. Video-assisted neck surgery: endoscopic resection of thyroid tumors with a very minimal neck wound. J Am Coll Surg. 1999. 188:697–703.

8. Ikeda Y, Takami H, Sasaki Y, Kan S, Niimi M. Endoscopic resection of thyroid tumors by the axillary approach. J Cardiovasc Surg (Torino). 2000. 41:791–792.

9. Ikeda Y, Takami H, Sasaki Y, Kan S, Niimi M. Endoscopic neck surgery by the axillary approach. J Am Coll Surg. 2000. 191:336–340.

10. Ng WT. Scarless endoscopic thyroidectomy: breast approach for better cosmesis. Surg Laparosc Endosc Percutan Tech. 2000. 10:339–340.

11. Ohgami M, Ishii S, Arisawa Y, Ohmori T, Noga K, Furukawa T, Kitajima M. Scarless endoscopic thyroidectomy: breast approach for better cosmesis. Surg Laparosc Endosc Percutan Tech. 2000. 10:1–4.

12. Yeh TS, Jan YY, Hsu BR, Chen KW, Chen MF. Video-assisted endoscopic thyroidectomy. Am J Surg. 2000. 180:82–85.

13. Miccoli P, Berti P, Bendinelli C, Conte M, Fasolini F, Martino E. Minimally invasive video-assisted surgery of the thyroid: a preliminary report. Langenbecks Arch Surg. 2000. 385:261–364.

14. Gagner M, Inabnet WB 3rd. Endoscopic thyroidectomy for solitary thyroid nodules. Thyroid. 2001. 11:161–164.

15. Park YL, Shin JH, Pae WK. Endoscopic thyroidectomy. J Korean Surg Soci. 2000. 59:25–29.

16. Kim JS, Kim KH, Ahn CH, Jeon HM, Kim EG, Jeon CS. A clinical analysis of gasless endoscopic thyroidectomy. Surg Laparosc Endosc Percutan Tech. 2001. 11:268–272.

17. Moon BY, Yi NJ. Supraclavicular endoscopic thyroidectomy early experience. J Korean Soc Endosc Laparosc Surg. 2002. 5:175–180.

18. Moon BY, Jeong GY. Endoscopy-assisted thyroidectomy bridge between conventional and endoscopic thyroidectomy. J Korean Soc Endosc Laparosc Surg. 2002. 5:170–174.

19. Bliss RD, Gauger PG, Delbridge LW. Surgeon's approach to the thyroid gland: surgical anatomy and the importance of technique. World J Surg. 2000. 24:891–897.

20. Rubino F, Pamoukian VN, Zhu JF, Deutsch H, Inabnet WB, Gagner M. Endoscopic endocrine neck surgery with carbon dioxide insufflation: the effect on intracranial pressure in a large animal model. Surgery. 2000. 128:1035–1042.

21. Inabnet WB, Jacob BP, Gagner M. Minimally invasive endoscopic thyroidectomy by a cervical approach. Surg Endosc. 2003. 17:1808–1811.

22. Shimazu K, Shiba E, Tamaki Y, Takiguchi S, Taniguchi E, Ohashi S, Noguchi S. Endoscopic thyroid surgery through the axillo-bilateral-breast approach. Surg Laparosc Endosc Percutan Tech. 2003. 13:196–201.

23. Choe JH, Kim SW, Chung KW, Park KS, Han WS, Noh DY, Oh SK, Youn YK. Endoscopic thyroidectomy using a new bilateral axillo-breast approach. World J Surg. 2007. 31:601–606.

24. Yamamoto M, Sasaki A, Asahi H, Shimada Y, Sato N, Nakajima J, Mashima R, Saito K. Endoscopic subtotal thyroidectomy for patients with Graves' disease. Surg Today. 2001. 31:1–4.

25. Shimizu K, Kitagawa W, Akasu H, Tanaka S. Endoscopic hemithyroidectomy and prophylactic lymph node dissection for micropapillary carcinoma of the thyroid by using a totally gasless anterior neck skin lifting method. J Surg Oncol. 2001. 77:217–220.

26. Chung YS, Choe JH, Kang KH, Kim SW, Chung KW, Park KS, Han WS, Noh DY, Oh SK, Youn YK. Endoscopic Thyroidectomy for Thyroid Malignancies: Comparison with Conventional Open Thyroidectomy. World J Surg. 2007. 14:[Epub ahead of Print].