Limits...
What is the evidence for endoscopic thyroidectomy in the management of benign thyroid disease?

Slotema ET, Sebag F, Henry JF - World J Surg (2008)

Bottom Line: Cosmetic outcome in extracervical approach is less troubled by size of the resected specimen compared with direct cervical approach.Long-term cosmetic outcome comparisons with conventional thyroidectomy have not been published.Currently it is not possible to recommend the application of ET based on evidence.

View Article: PubMed Central - PubMed

Affiliation: Department of Endocrine Surgery University Hospital Marseille, Service de Chirurgie Générale et Endocrinienne, CHU-Hôpital de la Timone, 264 Rue Saint-Pierre, 13385, Marseille cedex 05, France. e.t.slotema@lumc.nl

ABSTRACT

Background: Endoscopic thyroidectomy (ET) is a demanding surgical technique in which dissection of the gland is entirely performed with an endoscope, in a closed area maintained by insufflation or mechanical retraction. ET by direct cervical approach (anterior or lateral) is minimally invasive, but ET using an extracervical access (chest wall, breast, or axillary) is not. No technique seems to be universally accepted yet. This review was designed to clarify the existing evidence for performing endoscopic thyroid resections in the management of benign thyroid nodules.

Methods: A database search was conducted in PubMed and Embase from which summaries and abstracts were screened for relevant data, matching our definition. Publications were further assessed and assigned their respective levels of evidence. Additional data derived from our own unit's experience with endoscopic thyroidectomy were included.

Results: Thirty mainly retrospective cohort studies have been published in which morbidity, such as unilateral vocal cord palsy, is poorly evaluated. ET takes from 90 to 280 minutes for lobectomy by cervical access and total thyroidectomy by chest wall approach, respectively. Cosmetic outcome in extracervical approach is less troubled by size of the resected specimen compared with direct cervical approach. Extracervical approach avoids a neck scar but implies invasiveness in terms of dissection and postoperative discomfort. Long-term cosmetic outcome comparisons with conventional thyroidectomy have not been published.

Conclusions: Currently it is not possible to recommend the application of ET based on evidence. Reported complications stress the importance of advanced endoscopic skills. ET should only be offered to carefully selected patients and, therefore, a high volume of patients requiring thyroid surgery is needed. Superiority of endoscopic to conventional thyroidectomy has yet to be demonstrated. Possible advantages of endoscopic thyroid techniques and our patient's desire for the highest cosmetic outcome possible justify further development of ET in expert hands of endocrine surgeons.

Show MeSH

Related in: MedlinePlus

Indirect axillary approach
© Copyright Policy
Related In: Results  -  Collection


getmorefigures.php?uid=PMC2480507&req=5

Fig7: Indirect axillary approach

Mentions: The axillary approach can be used for large thyroid lesion but do not extend contralaterally. The patient is in supine position, and the ipsilateral arm on the side of the lesion placed at a 90° angle to the axis of the body. Three 5-mm incisions are placed below the anterior axillary line equidistant apart or one 30-mm incision is made for a 12-mm and 5-mm trocar, apart from the third trocar (5 mm) (Fig. 7). A 5-mm 0° optical scope or flexible laparoscope with CO2 insufflation at 4–9 mmHg pressure is introduced before starting sharp scissor dissection to dissect an avascular plane between platysma and pectoralis major muscle. A gasless axillary approach is feasible if an external lifting device is applied [16]. Next, the plane between SCM and sternohyoid muscle is developed to elevate the sternothyroid muscle and allow retraction anteriorly, exposing the ipsilateral thyroid gland. Harmonic scalpel and clips are used for division. A retrieval bag is used for extraction of the gland through the axilla [17–21]. All incisions are hidden in the axillary fossa.Fig. 7


What is the evidence for endoscopic thyroidectomy in the management of benign thyroid disease?

Slotema ET, Sebag F, Henry JF - World J Surg (2008)

Indirect axillary approach
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2480507&req=5

Fig7: Indirect axillary approach
Mentions: The axillary approach can be used for large thyroid lesion but do not extend contralaterally. The patient is in supine position, and the ipsilateral arm on the side of the lesion placed at a 90° angle to the axis of the body. Three 5-mm incisions are placed below the anterior axillary line equidistant apart or one 30-mm incision is made for a 12-mm and 5-mm trocar, apart from the third trocar (5 mm) (Fig. 7). A 5-mm 0° optical scope or flexible laparoscope with CO2 insufflation at 4–9 mmHg pressure is introduced before starting sharp scissor dissection to dissect an avascular plane between platysma and pectoralis major muscle. A gasless axillary approach is feasible if an external lifting device is applied [16]. Next, the plane between SCM and sternohyoid muscle is developed to elevate the sternothyroid muscle and allow retraction anteriorly, exposing the ipsilateral thyroid gland. Harmonic scalpel and clips are used for division. A retrieval bag is used for extraction of the gland through the axilla [17–21]. All incisions are hidden in the axillary fossa.Fig. 7

Bottom Line: Cosmetic outcome in extracervical approach is less troubled by size of the resected specimen compared with direct cervical approach.Long-term cosmetic outcome comparisons with conventional thyroidectomy have not been published.Currently it is not possible to recommend the application of ET based on evidence.

View Article: PubMed Central - PubMed

Affiliation: Department of Endocrine Surgery University Hospital Marseille, Service de Chirurgie Générale et Endocrinienne, CHU-Hôpital de la Timone, 264 Rue Saint-Pierre, 13385, Marseille cedex 05, France. e.t.slotema@lumc.nl

ABSTRACT

Background: Endoscopic thyroidectomy (ET) is a demanding surgical technique in which dissection of the gland is entirely performed with an endoscope, in a closed area maintained by insufflation or mechanical retraction. ET by direct cervical approach (anterior or lateral) is minimally invasive, but ET using an extracervical access (chest wall, breast, or axillary) is not. No technique seems to be universally accepted yet. This review was designed to clarify the existing evidence for performing endoscopic thyroid resections in the management of benign thyroid nodules.

Methods: A database search was conducted in PubMed and Embase from which summaries and abstracts were screened for relevant data, matching our definition. Publications were further assessed and assigned their respective levels of evidence. Additional data derived from our own unit's experience with endoscopic thyroidectomy were included.

Results: Thirty mainly retrospective cohort studies have been published in which morbidity, such as unilateral vocal cord palsy, is poorly evaluated. ET takes from 90 to 280 minutes for lobectomy by cervical access and total thyroidectomy by chest wall approach, respectively. Cosmetic outcome in extracervical approach is less troubled by size of the resected specimen compared with direct cervical approach. Extracervical approach avoids a neck scar but implies invasiveness in terms of dissection and postoperative discomfort. Long-term cosmetic outcome comparisons with conventional thyroidectomy have not been published.

Conclusions: Currently it is not possible to recommend the application of ET based on evidence. Reported complications stress the importance of advanced endoscopic skills. ET should only be offered to carefully selected patients and, therefore, a high volume of patients requiring thyroid surgery is needed. Superiority of endoscopic to conventional thyroidectomy has yet to be demonstrated. Possible advantages of endoscopic thyroid techniques and our patient's desire for the highest cosmetic outcome possible justify further development of ET in expert hands of endocrine surgeons.

Show MeSH
Related in: MedlinePlus