Endoscopic thyroidectomy for thyroid malignancies: comparison with conventional open thyroidectomy.
BACKGROUND
Endoscopic techniques have recently been applied to thyroid surgery. We developed the bilateral axillo-breast (BAB) approach for total thyroidectomy. The aims of this study were to evaluate the completeness of this approach for total thyroidectomy and to compare complications between endoscopic thyroidectomy and conventional open thyroidectomy.


METHODS
We analyzed 198 patients who underwent open thyroidectomy and 103 patients who underwent endoscopic thyroidectomy for papillary thyroid microcarcinoma between January 2003 and June 2006 at Seoul National University Hospital. The postoperative thyroglobulin (TG) level was used to assess the completeness of the two methods. Complications such as hypocalcemia or vocal cord palsy were also evaluated.


RESULTS
The mean hospitalization period was 3.18 days following open thyroidectomy and 3.04 days after endoscopic thyroidectomy. The 3-month postoperative TG levels were <1.0 ng/ml in 90.4% of patients after open total thyroidectomy and in 88.9% following endoscopic total thyroidectomy. Transient hypocalcemia occurred in 17.7% and 25.2% of patients, respectively. Permanent hypocalcemia occurred in 4.5% and 1.0% of patients, respectively. Permanent vocal cord palsy frequencies were 0.5% and 0%, respectively. There were no significant differences in postoperative TG levels, hypocalcemia, or permanent vocal cord palsy. Transient vocal cord palsy occurred in 2.5% of patients after open thyroidectomy and in 25.2% after endoscopic thyroidectomy (p < 0.0001), but it disappeared within 3 months. Cosmetic results were excellent after endoscopic thyroidectomy.


CONCLUSIONS
The bilateral axillo-breast (BAB) approach for endoscopic thyroidectomy shows insignificant postoperative complications, except transient vocal cord palsy, as well as good cosmetic results. It is also a feasible method for total thyroidectomy. Therefore, the BAB approach for endoscopic total thyroidectomy can be the surgical treatment of choice for selected cases of thyroid cancer.
Chung
Yoo Seung
YS
Department of Surgery, Seoul National University College of Medicine, Chongno-Gu, Seoul, Korea.
Choe
Jun-Ho
JH
Kang
Kyung-Ho
KH
Kim
Seok Won
SW
Chung
Ki-Wook
KW
Park
Kyoung Sik
KS
Han
Wonshik
W
Noh
Dong-Young
DY
Oh
Seung Keun
SK
Youn
Yeo-Kyu
YK
D000328:Adult; D000368:Aged; D004724:Endoscopy / Q000009:adverse effects* / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D013954:Thyroglobulin / Q000097:blood; D013964:Thyroid Neoplasms / Q000175:diagnosis / Q000601:surgery*; D013965:Thyroidectomy / Q000009:adverse effects* / Q000379:methods*; D016896:Treatment Outcome
D013954:Thyroglobulin