title: Total endoscopic thyroidectomy via a unilateral axillo-breast approach with two spatula-shaped wires each attached to the end of an endoscopic aspirator and a retractor-shaped wire.
abstract: OBJECTIVE
  With a total endoscopic thyroidectomy, it is extremely important to establish sufficient space. To solve this problem, the author has developed a new device, which is a retractor-shaped wire for retraction of the strap muscles without an additional port. Atraumatic tools for pushing and pulling without breaking the thyroid are necessary because intra-operative bleeding is afrequent cause of conversion to open procedure. To solve this problem, the author has developed a new device, which is a spatula-shaped wire that is attached to the end ofan endoscopic aspirator This spatula-shape wire can be used to push and pull the thyroidfirmly without it breaking of thyroid tissue.
  
  
  METHODS
  From 15 March 2011 to 15 April 2014, the author used these new devices in 18 consecutive patients who were considered eligible for the surgery.
  
  
  RESULTS
  Lobectomy with isthmusectomy was performed on 12 patients (67%). Through the same incisions, a subtotal thyroidectomy was accomplished infour cases (22%) and the Hartley-Dunhillprocedure was performed on two cases (11%). The mean specimen weight on the histological report was 33.12 grams (range, 8.4 to 79.6 grams). Two cases of left lobectomy with isthmusectomy had previously had a conventional right lobectomy. There was one case with the same procedure which had had a suspicious nodule on Graves'disease treated with radioactive iodine one and a halfyears ago. There was a case of chronic thyroiditis in one Dunhill procedure. No hemorrhage occurred during the procedures. There were three cases of subcutaneous bruising. There were no other complications detected and no cases were converted to open thyroidectomy.
  
  
  CONCLUSIONS
  Thyroid surgery with the unilateral axillo-breast approach and the new tools is safe and effective. These tools make it possible to operate on larger thyroid lesions and perform thyroid surgery on patients who have had traditional thyroid surgery, Graves' disease, and chronic thyroiditis.
authors.forename: Virawat
authors.initials: V
authors.lastname: Luangchana
mesh_terms: D001365:Axilla / Q000601:surgery*; D001940:Breast / Q000601:surgery*; D004724:Endoscopy / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods; D006801:Humans; D011183:Postoperative Complications; D012189:Retrospective Studies; D013959:Thyroid Diseases / Q000601:surgery*; D013965:Thyroidectomy / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods