title: Evaluation of an alternative, subclavicular approach to thyroidectomy.
abstract: BACKGROUND
  After presenting with the common finding of a nodular goiter, many patients refuse surgery because of the potential for a conspicuous anterior neck scar. Despite the development of endoscopic approaches to neck dissections, it can be difficult to remove a large thyroid tumor using such approaches.
  
  
  METHODS
  We attempted thyroid lobectomies via a subclavicular approach in three cases - three women whose ages ranged from 36-45 years old. Each patient was diagnosed with a cytologically-benign nodular goiter with a diameter greater than 60 mm. Subclavicular incisions were made with the length being determined by the size of the tumor and with the thyroid being approached laterally for resection.
  
  
  RESULTS
  Despite a maximum tumor diameter of greater than 70 mm, our operative technique was comparable to conventional methods with respect to surgical exposure, safety and operation time. Cosmetically, each patient was satisfied with the post-operative results.
  
  
  CONCLUSIONS
  We believe that the subclavicular approach to thyroidectomy is a safe and cosmetically-superior alternative to conventional surgery, even in cases that are too large to approach endoscopically.
authors.affiliation: Department of Surgery II, Nippon Medical School, Tokyo, Japan. hakasu@nms.ac.jp
authors.forename: Haruki
authors.initials: H
authors.lastname: Akasu
authors.forename: Kazuo
authors.initials: K
authors.lastname: Shimizu
authors.forename: Wataru
authors.initials: W
authors.lastname: Kitagawa
authors.forename: Ritsuko
authors.initials: R
authors.lastname: Ishii
authors.forename: Shigeo
authors.initials: S
authors.lastname: Tanaka
mesh_terms: D000328:Adult; D002921:Cicatrix; D005260:Female; D006042:Goiter / Q000601:surgery*; D006801:Humans; D008875:Middle Aged; D013965:Thyroidectomy / Q000379:methods*; D016896:Treatment Outcome