title: Increasing the size limit of benign thyroid lesions resectable by endoscopic thyroidectomy via a unilateral axillo-breast approach without gas insufflation.
abstract: BACKGROUND
  Endoscopic thyroidectomy is rarely attempted in patients with large goitrous lesions. We examined the feasibility and safety of endoscopic thyroidectomy via a unilateral axillo-breast approach without gas insufflation for resection of large thyroid tumors (≥4 cm).
  
  
  METHODS
  The study included 111 patients: 82 in group 1 (tumor diameter <4 cm) and 29 in group 2 (≥ 4 cm). Ninety-one patients underwent hemithyroidectomy and 20 underwent total thyroidectomy. Local complications, surgical outcomes, and pathological outcomes were compared between groups.
  
  
  RESULTS
  Postoperative permanent pathology revealed 24 follicular adenomas and 87 nodular hyperplasias. The mean tumor size in group 2 was 51.10 ± 7.66 mm compared to 25.24 ± 8.14 mm in group 1. The mean volume of the thyroid gland in group 2 was 15.60 ± 3.45 cm(3) compared to 11.27 ± 2.40 cm(3) in group 1 (p = 0.000). Mean operating time did not differ significantly between groups (p = 0.520). Postoperatively, minor hematomas were encountered in three patients (3.7%) in group 1. Three patients in group 1 (3.7%) and two in group 2 (6.9%) developed transient unilateral vocal cord palsy (p = 0.604). Temporary hypocalcemia was observed in six and one patients in groups 1 and 2, respectively (p = 1.000). No permanent recurrent laryngeal nerve palsy or hypoparathyroidism occurred in either group.
  
  
  CONCLUSIONS
  Our data support the safety and feasibility of endoscopic thyroidectomy via a unilateral axillo-breast approach without gas insufflation, even for the treatment of benign thyroid lesions ≥4 cm.
authors.affiliation: Department of Otorhinolaryngology, Yonsei University College of Medicine, 134 Shinchon-dong, Seodaemun-gu, Seoul 120-752, Korea.
authors.forename: Won Shik
authors.initials: WS
authors.lastname: Kim
authors.forename: Hyun Jun
authors.initials: HJ
authors.lastname: Hong
authors.forename: Yoo Seob
authors.initials: YS
authors.lastname: Shin
authors.forename: Eun Chang
authors.initials: EC
authors.lastname: Choi
authors.forename: Hong-Shik
authors.initials: HS
authors.lastname: Choi
authors.forename: Yoon Woo
authors.initials: YW
authors.lastname: Koh
mesh_terms: D000293:Adolescent; D000328:Adult; D001365:Axilla; D001940:Breast; D004724:Endoscopy; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007327:Insufflation; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013964:Thyroid Neoplasms / Q000473:pathology* / Q000601:surgery*; D013965:Thyroidectomy / Q000379:methods*; D055815:Young Adult