Clinical application of endoscopic thyroidectomy via an anterior chest wall approach.
BACKGROUND
Endoscopic minimally invasive surgery of the cervical region is currently used to treat benign thyroid disease. The aim of this study was to evaluate the safety, feasibility, and inflammatory response to endoscopic thyroidectomy (ET) via an anterior chest wall approach.


METHODS
Between January 2007 and January 2012, 320 patients underwent sub-total/total thyroidectomy. Of these, 160 had endoscopic surgery through an anterior chest wall approach (ET, group A) and 160 had traditional open surgery (group B). Demographics, operation time, intraoperative blood loss, complications, hospital stay, cost, and postoperative outcomes were compared between the 2 groups. Serum Interleukin-6 and C-reactive protein levels were measured preoperatively and at 2, 12, 24, and 48 hours postoperatively.


RESULTS
Patient demographics, tumor size, operation time, and pathologic diagnoses were similar in both groups. There was no difference in procedure time and postoperative complication rates. Intraoperative blood loss and length of hospital stay were significantly lower in group A (P<0.05), but cost was higher (P<0.05). Serum Interleukin-6 and C-reactive protein levels increased significantly after both procedures, with levels at the 24-hour and 48-hour time points higher in group B (P<0.05). Two cases in group A and 1 in group B developed a transient hoarse voice postoperatively, which recovered 7.5 days (range, 5 to 12 d) later. There were no serious complications during the 2-year follow-up.


CONCLUSIONS
ET through an anterior chest wall approach is safe and feasible for benign thyroid disease, and offers the advantage of no visible scar.
Department of Minimally Invasive Surgery, The First Affiliated Hospital of Nanjing Medical University, Jiangsu, China.
Xiaoyuan
X
Wang
Wei
W
Yang
Yueming
Y
Sun
D016063:Blood Loss, Surgical / Q000706:statistics & numerical data; D002681:China / Q000453:epidemiology; D004724:Endoscopy / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007902:Length of Stay / Q000639:trends; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D011446:Prospective Studies; D035441:Thoracic Wall / Q000601:surgery*; D013959:Thyroid Diseases / Q000601:surgery*; D013965:Thyroidectomy / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome