title: Endoscopic thyroid resection using cutaneous elevation in lieu of insufflation.
abstract: BACKGROUND
  Laparoscopic surgery to resect cervical masses has gained increasing acceptance during the past decade. This report describes the authors' technique and experience using total video endoscopic surgery to resect thyroid masses.
  
  
  METHODS
  The video camera is introduced through a 12-mm trocar inserted via a 10-mm infraclavicular incision in the sternal line. This incision will be hidden by the patient's undergarments postoperatively. An incision for a 12-mm trocar is made in each axilla, with additional incisions in the anterior chest made as necessary for the endoscope and instruments. Excellent exposure is produced by elevating the skin with hooks rather than by using carbon dioxide insufflation. This method reduces the incidence of subcutaneous emphysema and pneumomediastinum.
  
  
  RESULTS
  Twenty-two thyroid lesions were resected using total video endoscopic surgery (adenoma, 13; cancer, 5; benign cyst, 3; and Graves' disease, 1). Procedures included thyroidectomy (12), thyroidectomy and isthmusectomy (4), and subtotal thyroidectomy (2). Subtotal cervical adenectomy was performed in 3 patients with papillary carcinoma. Cosmetic results were excellent.
  
  
  CONCLUSIONS
  Endoscopic surgery of the neck is safe, minimally invasive, and produces excellent cosmetic results. However, it is in an early stage of development. Techniques have yet to be standardized, and specialized instruments are not available. The field is likely to mature as surgeons gain more experience.
authors.affiliation: Department of Otolaryngology, Head and Neck Surgery, Shiga University of Medical Science, Seta, Otsu, Shiga 520-2192, Japan. hkitano@belle.shiga-med.ac.jp
authors.forename: H
authors.initials: H
authors.lastname: Kitano
authors.forename: M
authors.initials: M
authors.lastname: Fujimura
authors.forename: T
authors.initials: T
authors.lastname: Kinoshita
authors.forename: H
authors.initials: H
authors.lastname: Kataoka
authors.forename: M
authors.initials: M
authors.lastname: Hirano
authors.forename: K
authors.initials: K
authors.lastname: Kitajima
mesh_terms: D000236:Adenoma / Q000601:surgery; D000293:Adolescent; D000328:Adult; D000368:Aged; D002102:Cadaver; D002291:Carcinoma, Papillary / Q000601:surgery; D062109:Dermatologic Surgical Procedures; D004724:Endoscopy / Q000379:methods*; D005260:Female; D006801:Humans; D007327:Insufflation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D013964:Thyroid Neoplasms / Q000601:surgery; D013965:Thyroidectomy / Q000379:methods*