title: Single-port unilateral transaxillary totally endoscopic thyroidectomy: A survival animal and cadaver feasibility study.
abstract: BACKGROUND
  Single-port unilateral axillary thyroidectomy has great potential to become a valid alternative technique for thyroid surgery. We tested the technique in a study on live animals and cadavers to evaluate the feasibility and reproducibility of the procedure.
  
  
  METHODS
  Institutional review board (IRB) approval was obtained in our university by the Council of Ethics for the study in surviving animals and cadavers. Subtotal thyroidectomy using unilateral axillary single port was performed in five dogs and five cadavers. Performing incision in the axillary fossa, a disposable single port was inserted. The dissection progressed for creating a subcutaneous tunnel to the subplatysmal region; after opening the platysma muscle and separation of the strap muscles, the thyroid gland was identified. After key anatomical landmarks were identified, the dissection was started at the upper pole towards the bottom, and to the isthmus. Specimens were extracted intact through the tunnel. Clinical and laboratorial observations of the experimental study in a 15-day follow-up and intraoperative data were documented.
  
  
  RESULTS
  All surgeries were performed in five animals which survived 15 days without postoperative complications. In the surgeries successfully performed in five cadavers, anatomical landmarks were recognised and intraoperative dissection of recurrent nerves and parathyroid glands was performed. Mean operative time was 64 min (46-85 min) in animals and 123 min (110-140 min) in cadavers, with a good cosmetic outcome since the incision was situated in the axillary fold.
  
  
  CONCLUSIONS
  The technique of single-port axillary unilateral thyroidectomy was feasible and reproducible in the cadavers and animal survival study, suggesting the procedure as an alternative to minimally invasive surgery of the neck.
authors.affiliation: Department of Surgery, Hospital Municipal Miguel Couto, Rio de Janeiro, Brazil.
authors.forename: Henrique Neubarth
authors.initials: HN
authors.lastname: Phillips
authors.affiliation: Department of Surgery, Hospital Universitário Gaffre-Guinle, Rio de Janeiro, Brazil.
authors.forename: Rossano Kepler Alvim
authors.initials: RK
authors.lastname: Fiorelli
authors.affiliation: Department of Post Graduation, Universidade Estadual Norte Fluminense, UENF, Rio de Janeiro, Brazil.
authors.forename: Marcelo Rios
authors.initials: MR
authors.lastname: Queiroz
authors.affiliation: Department of Post Graduation, Universidade Estadual Norte Fluminense, UENF, Rio de Janeiro, Brazil.
authors.forename: Andre Lacerda
authors.initials: AL
authors.lastname: Oliveira
authors.affiliation: Innovative Surgery Division, Klinikum Bremerhaven Reikenheide, Bremerhaven, Germany.
authors.forename: Ricardo
authors.initials: R
authors.lastname: Zorron
keywords: Endoscopic thyroidectomy; laparoscopic thyroidectomy; single port; transaxillary thyroidectomy