Yonsei Med J.  2007 Jun;48(3):480-487. 10.3349/ymj.2007.48.3.480.

Gasless Endoscopic Thyroidectomy via an Anterior Chest Wall Approach Using a Flap-Lifting System

• Cho YU
• Park IJ
• Choi KH
• Kim SJ
• Choi SK
• Hur YS
• Lee KY
• Ahn SI
• Hong KC
• Shin SH
• Kim KR
• Woo ZH

• KMID: 724104
• DOI: http://doi.org/10.3349/ymj.2007.48.3.480

Abstract

PURPOSE
Endoscopic thyroidectomy (ET) requires a proper working space for adequate visualization of anatomical structures and proper instrument manipulation. The purpose of this prospective study was to estimate the feasibility and safety of ET using an anterior chest wall approach without gas insufflation. MATERIALS AND METHODS: The working space was created under a direct and endoscopic view through a 3-cm incision on the anterior chest wall. A retracting device was then inserted to establish the working space, and subsequent procedures were performed endoscopically. All data were reviewed using a prospective database. RESULTS: We performed 30 ETs in patients with benign thyroid tumors from December 2003 to December 2005. The procedures were completed successfully in 29 patients (mean operative time: 160.6 min; range: 90-345 min). One patient with ET was converted to open thyroidectomy secondary to substernal extension of the tumor. None of the patients developed permanent postoperative hypocalcemia or recurrent laryngeal nerve paralysis. Three patients exhibited some degree of transient recurrent laryngeal nerve palsy. CONCLUSION: These data suggest that gasless ET using an anterior chest wall approach is safe and feasible in selected patients for treating benign thyroid tumors. This technique may offer good operative working space when performed by surgeons with relatively low-volume ET practices.

Keyword

Thyroidectomy; endoscopes; thyroid neoplasms

MeSH Terms

Adult
Endoscopy/*methods
Female
Humans
Male
Middle Aged
Reproducibility of Results
Thyroid Neoplasms/pathology/surgery
Thyroidectomy/instrumentation/*methods
Treatment Outcome

Figure

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  Fig. 1 A flap-lifting system. The spatula should be introduced into the main incision on the anterior chest wall, lifting the skin flap.

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  Fig. 2 Schematic drawing of the working space for gasless endoscopic thyroidectomy via the anterior chest wall approach.

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  Fig. 3 Operative field after installation of all devices. One surgeon handles the endoscope and the other uses the endoscopic forceps as dissectors, clamps, or for other functions.

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  Fig. 4 (A) Scars on the ipsilateral anterior chest wall one month post-op. (B) Scars are not visible when the patient is clothed.

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