title: Gasless endoscopic thyroidectomy via an anterior chest approach--a review of 219 cases with benign tumor.
abstract: BACKGROUND
  To get a better cosmetic effect, and to avoid even a small incision and scar in the anterior neck zone, we adapted gasless endoscopic thyroidectomy via anterior chest approach.
  
  
  METHODS
  From June 2004 to June 2008, 219 patients with thyroid diseases underwent gasless endoscopic thyroidectomy via anterior chest approach. The clinical and pathologic characteristics of patients, the type of operation, operative time, length of postoperative hospital stay, and postoperative complications were analyzed retrospectively.
  
  
  RESULTS
  All 219 operations were successfully performed endoscopically. Only three patients showed temporary paralysis of the recurrent laryngeal nerve (RLN), and all of them recovered within 1-3 months after the surgery. One patient showed permanent paralysis of the RLN, one patient developed a postoperative seroma, and one patient suffered a tracheal injury. There were no injuries to the superior laryngeal nerve or any hypoparathyroidism. No further complications, such as irritating cough, tetany, and emphysema developed after the operation. Because of the anterior chest wall approach, none of the patients had a surgical scar on the neck and all were satisfied with the cosmetic effect.
  
  
  CONCLUSIONS
  Gasless endoscopic thyroid surgery through anterior chest approach is a feasible and safe method. This technique had better cosmetic results and could constitute a new treatment modality for patients with benign tumors and can also be an effective alternative treatment for the selected patients with thyroid cancer.
authors.affiliation: Department of Otorhinolaryngology Head and Neck Surgery, Second Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510120, People's Republic of China.
authors.forename: Xiao-ming
authors.initials: XM
authors.lastname: Huang
authors.forename: Wei
authors.initials: W
authors.lastname: Sun
authors.forename: Liang
authors.initials: L
authors.lastname: Zeng
authors.forename: Xiang
authors.initials: X
authors.lastname: Liu
authors.forename: Xing
authors.initials: X
authors.lastname: Lu
authors.forename: Yao-dong
authors.initials: YD
authors.lastname: Xu
authors.forename: Zhi-gang
authors.initials: ZG
authors.lastname: Zhang
authors.forename: Geng
authors.initials: G
authors.lastname: Xu
mesh_terms: D000328:Adult; D044963:Biopsy, Fine-Needle; D002921:Cicatrix / Q000517:prevention & control; D015331:Cohort Studies; D004724:Endoscopy / Q000009:adverse effects / Q000379:methods*; D004954:Esthetics; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007150:Immunohistochemistry; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects / Q000379:methods; D011183:Postoperative Complications / Q000503:physiopathology; D012189:Retrospective Studies; D013909:Thorax; D013964:Thyroid Neoplasms / Q000473:pathology* / Q000601:surgery*; D013965:Thyroidectomy / Q000009:adverse effects / Q000379:methods*; D016896:Treatment Outcome; D055815:Young Adult