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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

Surgical procedures for the unilateral axillo-breast approach. (A) The inferior thyroid artery was identified close to the recurrent laryngeal nerve. (B) Hemithyroidectomy with paratracheal lymph node dissection is performed with careful dissection of the recurrent laryngeal nerve. (C) The left hemithyroidectomy-specimen-en bloc with ipsilateral CND is shown. (D) A specimen of large goiter resected via hemithyroidectomy (HT). The surgical specimens showed that thyroidectomy was accomplished without violation of the thyroid capsule.
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Figure 2: Surgical procedures for the unilateral axillo-breast approach. (A) The inferior thyroid artery was identified close to the recurrent laryngeal nerve. (B) Hemithyroidectomy with paratracheal lymph node dissection is performed with careful dissection of the recurrent laryngeal nerve. (C) The left hemithyroidectomy-specimen-en bloc with ipsilateral CND is shown. (D) A specimen of large goiter resected via hemithyroidectomy (HT). The surgical specimens showed that thyroidectomy was accomplished without violation of the thyroid capsule.

Mentions: The inferior thyroid artery was divided close to the thyroid gland to avoid injury to the recurrent laryngeal nerve (Fig. 2A). During this procedure, the lateral view of the thyroid gland from the axillary port helped to ensure complete preservation and exposure of the nerve (Fig. 1D). Proper application of an endoscopic cottonoid and a dissector to Berry's ligament realized the complete dissection of the thyroid gland from the trachea. To prevent thermal injury, especially near Berry's ligament, we took great care to maintain a distance of at least 5 mm from the major neurovascular structures and the trachea. The thyroid gland was then dissected from the trachea, and the isthmus was resected using the HS.


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)

Surgical procedures for the unilateral axillo-breast approach. (A) The inferior thyroid artery was identified close to the recurrent laryngeal nerve. (B) Hemithyroidectomy with paratracheal lymph node dissection is performed with careful dissection of the recurrent laryngeal nerve. (C) The left hemithyroidectomy-specimen-en bloc with ipsilateral CND is shown. (D) A specimen of large goiter resected via hemithyroidectomy (HT). The surgical specimens showed that thyroidectomy was accomplished without violation of the thyroid capsule.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 2: Surgical procedures for the unilateral axillo-breast approach. (A) The inferior thyroid artery was identified close to the recurrent laryngeal nerve. (B) Hemithyroidectomy with paratracheal lymph node dissection is performed with careful dissection of the recurrent laryngeal nerve. (C) The left hemithyroidectomy-specimen-en bloc with ipsilateral CND is shown. (D) A specimen of large goiter resected via hemithyroidectomy (HT). The surgical specimens showed that thyroidectomy was accomplished without violation of the thyroid capsule.
Mentions: The inferior thyroid artery was divided close to the thyroid gland to avoid injury to the recurrent laryngeal nerve (Fig. 2A). During this procedure, the lateral view of the thyroid gland from the axillary port helped to ensure complete preservation and exposure of the nerve (Fig. 1D). Proper application of an endoscopic cottonoid and a dissector to Berry's ligament realized the complete dissection of the thyroid gland from the trachea. To prevent thermal injury, especially near Berry's ligament, we took great care to maintain a distance of at least 5 mm from the major neurovascular structures and the trachea. The thyroid gland was then dissected from the trachea, and the isthmus was resected using the HS.

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