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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

Postoperative functional outcome [GRBAS scale, Voice Handicap Index (VHI)], easy fatigue during phonation, difficulty with high pitch and singing voice, hypoesthesia or paraesthesia in the neck or anterior chest wall, and swallowing difficulty were analyzed at postoperative months 1 (Post 1M) and 6 (Post 6M). * and ** Significant impairment compared to preoperative period (PreOP) (p<0.05). (A) Subjective parameters-open thyroidectomy group. (B) Subjective parameters-endoscopic thyroidectomy group.
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Figure 3: Postoperative functional outcome [GRBAS scale, Voice Handicap Index (VHI)], easy fatigue during phonation, difficulty with high pitch and singing voice, hypoesthesia or paraesthesia in the neck or anterior chest wall, and swallowing difficulty were analyzed at postoperative months 1 (Post 1M) and 6 (Post 6M). * and ** Significant impairment compared to preoperative period (PreOP) (p<0.05). (A) Subjective parameters-open thyroidectomy group. (B) Subjective parameters-endoscopic thyroidectomy group.

Mentions: As we previously described,1,24 the postoperative cosmetic results were better in group 3 (endo group) than in group 4 (open group), because the small incision scar in the axilla was completely covered when the patient's arm was in a natural position, so the periareolar incision was almost invisible. Most of the subjective parameters (hypoesthesia or paresthesia in the neck or anterior chest wall and difficulty swallowing) improved within 6 months in groups 3 and 4, but difficulty with a high pitched or singing voice didn't improve in group 4 (open group) until 6 months post-operation. VHI also didn't improve until 6 months post-operation in group 3 (endo group) (Fig. 3).


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)

Postoperative functional outcome [GRBAS scale, Voice Handicap Index (VHI)], easy fatigue during phonation, difficulty with high pitch and singing voice, hypoesthesia or paraesthesia in the neck or anterior chest wall, and swallowing difficulty were analyzed at postoperative months 1 (Post 1M) and 6 (Post 6M). * and ** Significant impairment compared to preoperative period (PreOP) (p<0.05). (A) Subjective parameters-open thyroidectomy group. (B) Subjective parameters-endoscopic thyroidectomy group.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 3: Postoperative functional outcome [GRBAS scale, Voice Handicap Index (VHI)], easy fatigue during phonation, difficulty with high pitch and singing voice, hypoesthesia or paraesthesia in the neck or anterior chest wall, and swallowing difficulty were analyzed at postoperative months 1 (Post 1M) and 6 (Post 6M). * and ** Significant impairment compared to preoperative period (PreOP) (p<0.05). (A) Subjective parameters-open thyroidectomy group. (B) Subjective parameters-endoscopic thyroidectomy group.
Mentions: As we previously described,1,24 the postoperative cosmetic results were better in group 3 (endo group) than in group 4 (open group), because the small incision scar in the axilla was completely covered when the patient's arm was in a natural position, so the periareolar incision was almost invisible. Most of the subjective parameters (hypoesthesia or paresthesia in the neck or anterior chest wall and difficulty swallowing) improved within 6 months in groups 3 and 4, but difficulty with a high pitched or singing voice didn't improve in group 4 (open group) until 6 months post-operation. VHI also didn't improve until 6 months post-operation in group 3 (endo group) (Fig. 3).

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