A Clinical Application of Gasless Endoscopic Thyroidectomy: Clinical Analysis of 300 Cases at a Single Institution

Kim, Ji Hoon; Bae, Ja Seong; Kim, Kee Hwan; Kim, Ji Il; Ahn, Chang Hyeok; Park, Woo Chan; Song, Byung Joo; Jung, Sang Seol; Kim, Jeong Soo

Abstract

PURPOSE: Endoscopic thyroidectomy has become a widely used operative method due to the recent advances in the operative technique and instruments and its cosmetic superiority. The aim of this study is to evaluate the technical feasibility and potential role of endoscopic thyroidectomy.
METHODS
Between December 1999 and December 2006, 300 patients with benign thyroid disease or thyroid cancer were treated by gasless endoscopic thyroidectomy with using the anterior chest wall approach at Uijongbu St. Mary's Hospital. We analyzed that clinicopathological features, the operative time, the operative method and the complications.
RESULTS
There were 261 cases of benign disease and 39 cases of malignant tumor. We generally performed lobectomy for benign thyroid disease. For malignant tumor, we performed 14 lobectomies, 6 total (or near total) thyroidectomies, 17 total (or near total) thyroidectomies with central lymph node dissection and 2 total (or near total) thyroidectomies with lateral lymph node dissection. The most frequent pathology in benign disease was nodular hyperplasia, and in malignant disease it was papillary carcinoma. The mean operative time was 122.2 minutes. For the patients with thyroid cancer, the mean operative time for thyroid cancer surgery without lymph node dissection (20 cases) and thyroid cancer surgery with lymph node dissection (19 cases) was 144 and 177 minutes, respectively. There were 34 cases of complication (11.33%) with 11 cases of transient hoarseness, 9 cases of transient hypocalcemia and 1 case of permanent hypocalcemia.
CONCLUSION
Endoscopic thyroidectomy is a safe and technically feasible alternative to conventional thyroidectomy in patients with benign disease. In patients with thyroid cancer, we suggest that that endoscopic thyroidectomy can be a good alternative to conventional thyroid surgery in highly selected cases. Larger series and longer follow-up evaluation are necessary to confirm our findings.