title: Gasless endoscopic thyroidectomy via an anterior chest wall approach using a flap-lifting system.
abstract: OBJECTIVE
  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.
  
  
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Surgery, Inha University Hospital, Inha University College of Medicine, 7-206 3-ga, Sinheung-dong, Jung-gu, Incheon 400-711, Korea.
authors.forename: Young Up
authors.initials: YU
authors.lastname: Cho
authors.forename: Il Jae
authors.initials: IJ
authors.lastname: Park
authors.forename: Kyong-Ho
authors.initials: KH
authors.lastname: Choi
authors.forename: Sei Joong
authors.initials: SJ
authors.lastname: Kim
authors.forename: Sun Keun
authors.initials: SK
authors.lastname: Choi
authors.forename: Yoon Seok
authors.initials: YS
authors.lastname: Hur
authors.forename: Keon-Young
authors.initials: KY
authors.lastname: Lee
authors.forename: Seung-Ik
authors.initials: SI
authors.lastname: Ahn
authors.forename: Kee-Chun
authors.initials: KC
authors.lastname: Hong
authors.forename: Seok Hwan
authors.initials: SH
authors.lastname: Shin
authors.forename: Kyung Rae
authors.initials: KR
authors.lastname: Kim
authors.forename: Ze Hong
authors.initials: ZH
authors.lastname: Woo
mesh_terms: D000328:Adult; D004724:Endoscopy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D013964:Thyroid Neoplasms / Q000473:pathology / Q000601:surgery; D013965:Thyroidectomy / Q000295:instrumentation / Q000379:methods*; D016896:Treatment Outcome