Endoscopic thyroidectomy via a unilateral axillo-breast approach without gas insufflation for unilateral benign thyroid lesions

Y. W. Koh, J. W. Kim, S. W. Lee, E. C. Choi

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Abstract

Background: The usefulness of various endoscopic thyroid surgery techniques has been reviewed. Recently, the authors developed a unilateral axillo-breast approach for endoscopic hemithyroidectomy to minimize the visible scar in a natural position and to overcome the limitation of instrumentation. The feasibility and safety of endoscopic thyroid surgery was examined via a novel approach without gas insufflation. Methods: This study enrolled 52 consecutive patients undergoing endoscopic hemithyroidectomy via a unilateral axillo-breast approach without gas insufflation. A skin incision parallel to the skin crease was made in the axillary fossa for insertion of a 10-mm 30° rigid endoscope and endoscopic instruments. To create a working space, an external retractor was inserted through the skin incision in the axilla and raised using a lifting device. A second 1.0-cm skin incision was made along the upper margin of the mammary areola on the tumor side for insertion of a 12-mm trocar. Results: Postoperative pathology showed 11 follicular adenomas, 1 follicular carcinoma, and 40 benign thyroid lesions. The operating time for the first 10 hemithyroidectomies was 154 ± 64.88 min, which was 34.77 min longer than for the last 42 hemithyroidectomies (119.23 ± 31.47 min; p = 0.1314). The amount of postoperative drainage was 236.63 ± 118.67 ml, and the duration of drainage was 4.54 ± 1.42 days. The postoperative hospital stay was 6.37 ± 2.83 days. Overall, seven patients (7/52, 13.5%) experienced perioperative complications, including one transient recurrent laryngeal nerve palsy (1.9%), five seromas (9.6%), and one hematoma (1.9%), which arose from a subplatysmal skin flap. Conclusion Although the aspect of invasiveness could be improved, endoscopic hemithyroidectomy via a unilateral axillo-breast approach without gas insufflation is safe and effective and appears to provide better cosmetic results and a shorter operation time than other endoscopic methods for managing selective unilateral benign thyroid lesions.

Original languageEnglish
Pages (from-to)2053-2060
Number of pages8
JournalSurgical endoscopy
Volume23
Issue number9
DOIs
Publication statusPublished - 2009 Sep

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All Science Journal Classification (ASJC) codes

  • Surgery

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