title: Gasless endoscopic thyroidectomy using trans-axillary approach; surgical outcome of 581 patients.
abstract: OBJECTIVE
  During the past decade, various techniques of endoscopic thyroid surgery have been introduced. We have developed a novel method of gasless endoscopic thyroidectomy via an axillary approach. The present report describes the technique of this method, and analyzes its surgical outcome.
  
  
  METHODS
  Between Nov. 2001 and Dec. 2007 (actual operation period was 50 months), 581 patients with thyroid tumors underwent gasless endoscopic thyroidectomy via an axillary approach. The clinical and pathologic characteristics of patients, operation type, operation time, post operative hospital stay and post operative complications were analyzed retrospectively.
  
  
  RESULTS
  Among the 581 patients, 171 patients had benign tumor and 410 patients had malignant tumor. There was no conversion to open surgery. The operating time and the length of post-operative hospital stay were 129.4+/-51.3 minutes, 3.3+/-1.7 days in benign tumor, and 135.5+/-47 minutes, 3.4+/-0.9 days in malignant tumors, respectively. The tumor size was 2.7+/-1.2 cm in benign tumor and 0.78+/-0.5 cm in malignancy. Central compartment lymph node metastasis was found in 112 (27.3%) patients and lateral neck lymph node metastasis in 13 (3.1%) patients. As post-operative complications, transient hypocalcemia occurred in 19 patients and transient hoarseness was in 13 patients and permanent vocal cord palsy occurred in 2 patients. In the TNM stage, 366 (89.2%) patients were stage I, 43 (10.5%) patients were stage III and 1 (0.2%) patient was stage IVA.
  
  
  CONCLUSIONS
  According to our experience, gasless endoscopic thyroidectomy using a trans-axillary approach is a feasible and safe method. Endoscopic thyroid surgery has become a new treatment modality for the patients with benign tumors and can be an effective alternative treatment for the selected patients with thyroid cancer.
authors.affiliation: Department of Surgery, Yonsei University College of Medicine, Seodaemun-gu, Seoul, South Korea.
authors.forename: Sang-Wook
authors.initials: SW
authors.lastname: Kang
authors.forename: Jong Ju
authors.initials: JJ
authors.lastname: Jeong
authors.forename: Ji-Sup
authors.initials: JS
authors.lastname: Yun
authors.forename: Tae Yon
authors.initials: TY
authors.lastname: Sung
authors.forename: Seung Chul
authors.initials: SC
authors.lastname: Lee
authors.forename: Yong Sang
authors.initials: YS
authors.lastname: Lee
authors.forename: Kee-Hyun
authors.initials: KH
authors.lastname: Nam
authors.forename: Hang Seok
authors.initials: HS
authors.lastname: Chang
authors.forename: Woong Youn
authors.initials: WY
authors.lastname: Chung
authors.forename: Cheong Soo
authors.initials: CS
authors.lastname: Park
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D004724:Endoscopy / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D006996:Hypocalcemia / Q000209:etiology; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012189:Retrospective Studies; D013964:Thyroid Neoplasms / Q000473:pathology / Q000601:surgery*; D013965:Thyroidectomy / Q000009:adverse effects / Q000379:methods*; D014826:Vocal Cord Paralysis / Q000209:etiology