Endoscopic completion thyroidectomy by the bilateral axillo-breast approach.
OBJECTIVE
Bilateral axillo-breast approach (BABA) endoscopic thyroidectomy has been successfully used for various thyroid diseases, with an excellent cosmetic outcome. Patients with a confirmed thyroid malignancy on a permanent thyroid section after endoscopic thyroid lobectomy require completion thyroidectomy. Here, we sought to demonstrate the feasibility of endoscopic completion thyroidectomy by BABA.


METHODS
Between June, 2006 and February, 2009, 13 patients underwent endoscopic completion thyroidectomy by BABA for minimally invasive follicular thyroid and papillary thyroid carcinomas diagnosed after BABA endoscopic thyroid lobectomy. The median interval between thyroid lobectomy and completion thyroidectomy was 5.6 months (range, 4.2-28.2 mo). We used the same port sites (bilateral breast and axillary region) as were created at the initial operation. Flap adhesion was minimal. After identifying the remnant thyroid lobe, completion thyroidectomy was performed under full visualization of the thyroidal vessels, parathyroid glands, and recurrent laryngeal nerve.


RESULTS
We performed 5 right and 8 left endoscopic completion thyroidectomies by BABA. The mean operation time was 109.3±23.3 minutes. There were no cases of open conversion. The resulting 6 (46.2%) cases of transient hypocalcemia resolved within 2 postoperative weeks and there were no cases of vocal cord palsy or wound infection. One patient had immediate postoperative breast flap bleeding that required cauterization. No patient had evidence of recurrence, as indicated by follow-up neck ultrasonography and serum thyroglobulin levels. The cosmetic outcomes were excellent and all patients were satisfied.


CONCLUSIONS
BABA endoscopic thyroidectomy appears feasible and safe procedure for completion thyroidectomy, making it a viable technique for reapplication in cases of thyroid carcinoma diagnosed after endoscopic thyroid lobectomy.
Department of Surgery, Seoul National University College of Medicine, Seoul, Korea.
Su-jin
SJ
Kim
Kyu Eun
KE
Lee
Jun-Ho
JH
Choe
Jeonghun
J
Lee
Do Hoon
do H
Koo
Seung Keun
SK
Oh
Yeo-Kyu
YK
Youn
D000293:Adolescent; D000328:Adult; D001365:Axilla; D001940:Breast; D004724:Endoscopy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D013964:Thyroid Neoplasms / Q000175:diagnosis / Q000601:surgery; D013965:Thyroidectomy / Q000379:methods*; D055815:Young Adult