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Endoscopic thyroidectomy via an axillo-breast approach without gas insufflation for benign thyroid nodules and micropapillary carcinomas: preliminary results.

Hong HJ, Kim WS, Koh YW, Lee SY, Shin YS, Koo YC, Park YA, Choi EC - Yonsei Med. J. (2011)

Bottom Line: Postoperative functional outcome, local complications, surgical outcomes, and pathological outcomes were compared between the groups.The overall perioperative complications did not differ significantly between the groups.Although it has the advantage of better cosmetic results over open thyroidectomy, there is room for improvement in terms of lessening its invasiveness and shortening the operative time.

View Article: PubMed Central - PubMed

Affiliation: Department of Otorhinolaryngology, Yonsei University College of Medicine, 250 Seongsan-ro, Seodaemun-gu, Seoul 120-752, Korea.

ABSTRACT

Purpose: To examine the feasibility of endoscopic thyroidectomy (ET) via an axillo- breast approach without gas insufflation for large thyroid tumors and micropapillary carcinomas.

Materials and methods: The patients in the benign group were separated into groups 1 (n=95, <4 cm in tumor diameter) and 2 (n=37, ≥4 cm in tumor diameter). Also, 57 patients in the micropapillary carcinoma group underwent an endoscopic hemithyroidectomy (HT) (group 3) and were compared with 60 patients who received conventional open HT (group 4). Postoperative functional outcome, local complications, surgical outcomes, and pathological outcomes were compared between the groups.

Results: In the benign group, there was no significant difference in mean operating time, hospital stay, or overall perioperative complications between the two groups. In the micropapillary carcinoma group, mean operating time and hospital stay in group 3 were significantly longer than in group 4 (p=0.015 and p≤0.001). The overall perioperative complications did not differ significantly between the groups. The postoperative cosmetic result was better in groups 1-3 (endo group) than in group 4 (open group).

Conclusion: ET via a gasless axillo-breast approach seems to be a safe procedure even for benign thyroid lesions ≥4 cm and micropapillary carcinomas. Although it has the advantage of better cosmetic results over open thyroidectomy, there is room for improvement in terms of lessening its invasiveness and shortening the operative time.

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Related in: MedlinePlus

Axillo-breast approach. (A) A working space is created by inserting an external retractor (Sejong Medical Corporation) through the axillary skin incision. The periareolar skin incision is used for the placement of a 12-mm trocar. (B) The superior thyroid artery (left) is easily identified and sealed off using the harmonic scalpel. (C) The left superior parathyroid gland was identified and preserved between the recurrent laryngeal nerve and common carotid artery (CCA). (D) The left endoscopic hemithyroidectomy was completed.
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Figure 1: Axillo-breast approach. (A) A working space is created by inserting an external retractor (Sejong Medical Corporation) through the axillary skin incision. The periareolar skin incision is used for the placement of a 12-mm trocar. (B) The superior thyroid artery (left) is easily identified and sealed off using the harmonic scalpel. (C) The left superior parathyroid gland was identified and preserved between the recurrent laryngeal nerve and common carotid artery (CCA). (D) The left endoscopic hemithyroidectomy was completed.

Mentions: The operative technique was performed as previously described.1,24 The patient was placed in the supine position under general anesthesia. The neck was extended slightly and the lesion-side arm was raised to fully expose the axilla. The surgical team consisted of the surgeon and one assistant, who was required to hold a 30° rigid endoscope and a suction-irrigator. A 4.5-5.5 cm skin incision was made parallel to the skin crease in the axillary fossa, through which we inserted the rigid endoscope and the endoscopic instruments (Fig. 1A). The skin was elevated above the pectoralis major muscle exclusively under direct vision, using monopolar cauterization through the axillary skin incision, until the anterior border of the sternocleidomastoid muscle was exposed. To create a working space, we inserted an external retractor (Sejong Medical Corporation, Gyoha, Korea) through the skin incision in the axilla, which was raised using a lifting device. A second 1.0 cm skin incision was made along the upper margin of the mammary areola on the tumor side for inserting a 12 mm trocar, which was directed to the midline of the sternal notch. Using only a harmonic scalpal (HS; Harmonic Ace 36P®; Johnson & Johnson Medical, Cincinnati, OH, USA), we dissected the anterior border of the sternocleidomastoid muscle from the sternohyoid muscle and, in some cases, divided the omohyoid muscle.


Endoscopic thyroidectomy via an axillo-breast approach without gas insufflation for benign thyroid nodules and micropapillary carcinomas: preliminary results.

Hong HJ, Kim WS, Koh YW, Lee SY, Shin YS, Koo YC, Park YA, Choi EC - Yonsei Med. J. (2011)

Axillo-breast approach. (A) A working space is created by inserting an external retractor (Sejong Medical Corporation) through the axillary skin incision. The periareolar skin incision is used for the placement of a 12-mm trocar. (B) The superior thyroid artery (left) is easily identified and sealed off using the harmonic scalpel. (C) The left superior parathyroid gland was identified and preserved between the recurrent laryngeal nerve and common carotid artery (CCA). (D) The left endoscopic hemithyroidectomy was completed.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3104441&req=5

Figure 1: Axillo-breast approach. (A) A working space is created by inserting an external retractor (Sejong Medical Corporation) through the axillary skin incision. The periareolar skin incision is used for the placement of a 12-mm trocar. (B) The superior thyroid artery (left) is easily identified and sealed off using the harmonic scalpel. (C) The left superior parathyroid gland was identified and preserved between the recurrent laryngeal nerve and common carotid artery (CCA). (D) The left endoscopic hemithyroidectomy was completed.
Mentions: The operative technique was performed as previously described.1,24 The patient was placed in the supine position under general anesthesia. The neck was extended slightly and the lesion-side arm was raised to fully expose the axilla. The surgical team consisted of the surgeon and one assistant, who was required to hold a 30° rigid endoscope and a suction-irrigator. A 4.5-5.5 cm skin incision was made parallel to the skin crease in the axillary fossa, through which we inserted the rigid endoscope and the endoscopic instruments (Fig. 1A). The skin was elevated above the pectoralis major muscle exclusively under direct vision, using monopolar cauterization through the axillary skin incision, until the anterior border of the sternocleidomastoid muscle was exposed. To create a working space, we inserted an external retractor (Sejong Medical Corporation, Gyoha, Korea) through the skin incision in the axilla, which was raised using a lifting device. A second 1.0 cm skin incision was made along the upper margin of the mammary areola on the tumor side for inserting a 12 mm trocar, which was directed to the midline of the sternal notch. Using only a harmonic scalpal (HS; Harmonic Ace 36P®; Johnson & Johnson Medical, Cincinnati, OH, USA), we dissected the anterior border of the sternocleidomastoid muscle from the sternohyoid muscle and, in some cases, divided the omohyoid muscle.

Bottom Line: Postoperative functional outcome, local complications, surgical outcomes, and pathological outcomes were compared between the groups.The overall perioperative complications did not differ significantly between the groups.Although it has the advantage of better cosmetic results over open thyroidectomy, there is room for improvement in terms of lessening its invasiveness and shortening the operative time.

View Article: PubMed Central - PubMed

Affiliation: Department of Otorhinolaryngology, Yonsei University College of Medicine, 250 Seongsan-ro, Seodaemun-gu, Seoul 120-752, Korea.

ABSTRACT

Purpose: To examine the feasibility of endoscopic thyroidectomy (ET) via an axillo- breast approach without gas insufflation for large thyroid tumors and micropapillary carcinomas.

Materials and methods: The patients in the benign group were separated into groups 1 (n=95, <4 cm in tumor diameter) and 2 (n=37, ≥4 cm in tumor diameter). Also, 57 patients in the micropapillary carcinoma group underwent an endoscopic hemithyroidectomy (HT) (group 3) and were compared with 60 patients who received conventional open HT (group 4). Postoperative functional outcome, local complications, surgical outcomes, and pathological outcomes were compared between the groups.

Results: In the benign group, there was no significant difference in mean operating time, hospital stay, or overall perioperative complications between the two groups. In the micropapillary carcinoma group, mean operating time and hospital stay in group 3 were significantly longer than in group 4 (p=0.015 and p≤0.001). The overall perioperative complications did not differ significantly between the groups. The postoperative cosmetic result was better in groups 1-3 (endo group) than in group 4 (open group).

Conclusion: ET via a gasless axillo-breast approach seems to be a safe procedure even for benign thyroid lesions ≥4 cm and micropapillary carcinomas. Although it has the advantage of better cosmetic results over open thyroidectomy, there is room for improvement in terms of lessening its invasiveness and shortening the operative time.

Show MeSH
Related in: MedlinePlus