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


CONCLUSIONS
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.
Department of Otolaryngology-Head and Neck Surgery, Soonchunhyang University College of Medicine, Bucheon, Korea.
Y W
YW
Koh
J W
JW
Kim
S W
SW
Lee
E C
EC
Choi
D018263:Adenocarcinoma, Follicular / Q000601:surgery; D000236:Adenoma / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D001365:Axilla; D001940:Breast; D004322:Drainage; D004724:Endoscopy / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D006406:Hematoma / Q000209:etiology; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology; D049291:Seroma / Q000209:etiology; D013959:Thyroid Diseases / Q000601:surgery*; D013964:Thyroid Neoplasms / Q000601:surgery*; D013965:Thyroidectomy / Q000379:methods*; D014826:Vocal Cord Paralysis / Q000209:etiology; D055815:Young Adult