title: Postauricular and axillary approach endoscopic neck surgery: a new technique.
abstract: BACKGROUND
  While the bilateral axillo-breast approach (BABA) to endoscopic neck surgery resolves various benign and malignant thyroid and parathyroid diseases with minimal adverse effects and excellent cosmetic outcomes, it involves circumareolar incisions. Many patients, especially young female patients, are reluctant to have their breast involved. Consequently, we developed the postauricular and axillary approach (PAA) that uses postauricular incisions.
  
  
  METHODS
  From June 2006 to December 2007, we treated 10 patients with PAA endoscopic neck surgery. After subcutaneous infiltration with diluted epinephrine solution, the subplatysmal and subcutaneous spaces were dissected. Two axillary ports and two postauricular ports were used and low-pressure CO2 insufflation generated operative space. After dividing the midline between the strap muscles, the isthmus was divided and the thyroid lobe was dissected with ultrasonic shears and excised after careful identification of the recurrent laryngeal nerve and parathyroid glands. Malignant lesions were treated with contralateral thyroid lobectomy. For parathyroid adenomas, we performed parathyroidectomy after dividing the strap muscles in the midline.
  
  
  RESULTS
  Two thyroid lobectomies, one parathyroidectomy, one subtotal thyroidectomy, and six total thyroidectomies were performed by PAA endoscopic neck surgery. The mean operation time was 210.0+/-43.7 min. There were no cases of conversion to open surgery, permanent vocal cord palsy, or facial nerve palsy. None of the thyroidectomy patients exhibited hypocalcemia. The cosmetic outcomes were excellent and all patients were satisfied.
  
  
  CONCLUSIONS
  PAA endoscopic neck surgery is a feasible method for thyroid and parathyroid surgery that permits good operative visualization and has minimal adverse effects and excellent cosmetic outcomes.
authors.affiliation: Department of Surgery, Seoul National University College of Medicine, and Seoul National University Hospital, 101 Daehangno, Jongno-gu, Seoul, 110-744, Republic of Korea.
authors.forename: Kyu Eun
authors.initials: KE
authors.lastname: Lee
authors.forename: Hoon Yub
authors.initials: HY
authors.lastname: Kim
authors.forename: Won Seo
authors.initials: WS
authors.lastname: Park
authors.forename: Jun-Ho
authors.initials: JH
authors.lastname: Choe
authors.forename: Mi Ra
authors.initials: MR
authors.lastname: Kwon
authors.forename: Seung Keun
authors.initials: SK
authors.lastname: Oh
authors.forename: Yeo-Kyu
authors.initials: YK
authors.lastname: Youn
mesh_terms: D000236:Adenoma / Q000601:surgery; D000293:Adolescent; D000328:Adult; D001365:Axilla; D054644:Ear Auricle; D004724:Endoscopy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D010282:Parathyroid Neoplasms / Q000601:surgery; D016105:Parathyroidectomy / Q000379:methods*; D013964:Thyroid Neoplasms / Q000601:surgery; D013965:Thyroidectomy / Q000379:methods*; D055815:Young Adult