title: Single-Incision, Gasless, Endoscopic Trans-Axillary Total Thyroidectomy: A Feasible and Oncologic Safe Surgery in Patients with Papillary Thyroid Carcinoma.
abstract: BACKGROUND
  The aim of this study is to compare the feasibility and oncologic safety of Single-incision, gasless, Endoscopic trans-axillary bilateral Total thyroidectomy (SET) with open cervical total thyroidectomy in patients with papillary thyroid carcinoma (PTC).
  
  
  METHODS
  From March 2008 to December 2012, PTC patients underwent bilateral total thyroidectomy. Conventional, open surgery was performed on 538 patients (Group O) and endoscopic surgery was performed on 200 patients (Group E). We analyzed the patient's clinicopathologic, postoperative complications, and surgical completeness.
  
  
  RESULTS
  The mean ages of the patients were 48.9 ± 0.5 (range = 24-77) in Group O and 39.5 ± 0.8 (range = 17-73) in Group E with statistical significance (P < .001). Percentage of female patients were 74.3% in Group O and 96.0% in Group E with statistical significance (P < .001). The postoperative hospital stay in Group O was significantly longer than Group E (4.60 ± 0.05 versus 3.30 ± 0.05; P < .001). The operation time in Group E was significantly longer than Group O (93.9 ± 1.3 versus 142.6 ± 3.3; P < .001). More transient hypocalcemia was found in Group O compared to Group E with statistical significance (28.1% versus 22.4%; P < .001). There were no significant differences with respect to permanent hypocalcemia, permanent recurrent laryngeal nerve palsy, seroma, and hematoma. The mean 1 year-stimulated sTg was 0.23 ± 0.03 and 0.18 ± 0.02 in Group O and E, respectively. Tumor recurrence during short-term follow-up at neck ultrasonography (1 year) was detected in 4 patients in Group O.
  
  
  CONCLUSIONS
  SET is safe and effective, not only for low-risk patients with early-detected cancer, but also for selected cases of advanced cancer.
authors.affiliation: 1 Department of Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine , Seoul, Republic of Korea.
authors.forename: Eun Young
authors.initials: EY
authors.lastname: Kim
authors.affiliation: 1 Department of Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine , Seoul, Republic of Korea.
authors.forename: Kwan Ho
authors.initials: KH
authors.lastname: Lee
authors.affiliation: 1 Department of Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine , Seoul, Republic of Korea.
authors.forename: Yong Lai
authors.initials: YL
authors.lastname: Park
authors.affiliation: 1 Department of Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine , Seoul, Republic of Korea.
authors.forename: Chan Heun
authors.initials: CH
authors.lastname: Park
authors.affiliation: 2 Department of Surgery, Yonsei University College of Medicine , Seoul, Republic of Korea.
authors.forename: Cho Rok
authors.initials: CR
authors.lastname: Lee
authors.affiliation: 2 Department of Surgery, Yonsei University College of Medicine , Seoul, Republic of Korea.
authors.forename: Jong Ju
authors.initials: JJ
authors.lastname: Jeong
authors.affiliation: 2 Department of Surgery, Yonsei University College of Medicine , Seoul, Republic of Korea.
authors.forename: Kee-Hyun
authors.initials: KH
authors.lastname: Nam
authors.affiliation: 2 Department of Surgery, Yonsei University College of Medicine , Seoul, Republic of Korea.
authors.forename: Woong Youn
authors.initials: WY
authors.lastname: Chung
authors.affiliation: 1 Department of Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine , Seoul, Republic of Korea.
authors.forename: Ji-Sup
authors.initials: JS
authors.lastname: Yun
mesh_terms: D000328:Adult; D000368:Aged; D001365:Axilla; D002291:Carcinoma, Papillary / Q000556:secondary / Q000601:surgery*; D016022:Case-Control Studies; D004724:Endoscopy / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000601:surgery*; D009367:Neoplasm Staging; D061646:Operative Time; D011183:Postoperative Complications / Q000209:etiology; D013964:Thyroid Neoplasms / Q000473:pathology / Q000601:surgery*; D013965:Thyroidectomy / Q000379:methods; D055815:Young Adult
keywords: papillary thyroid carcinoma; thyroglobulin; transaxillary