title: A novel method for creating working space during endoscopic thyroidectomy via bilateral areolar approach.
abstract: BACKGROUND
  Endoscopic thyroidectomy (ET) can be performed through the bilateral areolar approach (BAA). A working space (WS) is typically created on the surface of the pectoral fascia in the chest wall and in the subplatysmal space in the neck. There are several limitations of using this WS. The aim of this study was to establish a new WS for ET.
  
  
  METHODS
  A retrospective review was performed on 85 patients with benign thyroid nodules who had undergone ET through a BAA. A WS was created between the anterior and poster layers of the superficial pectoral fascia (SPF) in the chest and underneath the deep layer of the investing layer (IL) in the neck.
  
  
  RESULTS
  The time for creating the WS was 7.2 ± 2.1 (range, 5-12) minutes. No hemorrhage occurred during the procedure. Fat liquefaction occurred in 2 patients. Edema of the neck skin flap presented as lack of a suprasternal notch. No skin numbness occurred. No patient required postoperative pain medication. All patients were extremely satisfied with the cosmetic results.
  
  
  CONCLUSIONS
  This new method of establishing a WS between the two layers of the SPF and underneath the IL is simple and fast, provides good exposure, yields less postoperative pain, and has a lower risk of skin burn.
authors.affiliation: 1 Department of Thyroid and Breast Surgery, Affiliated Nanhai Hospital of Southern Medical University , Foshan, People's Republic of China .
authors.forename: Yi-Hong
authors.initials: YH
authors.lastname: Tan
authors.forename: Guo-Neng
authors.initials: GN
authors.lastname: Du
authors.forename: Yu-Gen
authors.initials: YG
authors.lastname: Xiao
authors.forename: Wan-Shou
authors.initials: WS
authors.lastname: Qiu
authors.forename: Tao
authors.initials: T
authors.lastname: Wu
mesh_terms: D000328:Adult; D000368:Aged; D004724:Endoscopy / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain; D011183:Postoperative Complications; D012189:Retrospective Studies; D013964:Thyroid Neoplasms / Q000601:surgery*; D013965:Thyroidectomy / Q000009:adverse effects / Q000379:methods*; D055815:Young Adult