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Endoscopic thyroid surgery via a breast approach: a single institution's experiences.

Kim YS, Joo KH, Park SC, Kim KH, Ahn CH, Kim JS - BMC Surg (2014)

Bottom Line: Temporary and permanent hypoparathyroidism requiring calcium and vitamin D supplementation developed in 32 (7.1%) and 4 (0.9%) patients, respectively.Transient vocal cord paresis occurred in 20 (4.4%) patients.For patients with benign and low-risk malignant thyroid disease, endoscopic thyroidectomy via a breast approach is a safe, feasible, and minimally invasive surgical method with minimal complications.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Surgery, Uijeongbu St, Mary's Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu, Korea. drbreast@catholic.ac.kr.

ABSTRACT

Background: Thyroid carcinoma in young women is rapidly increasing, and cosmesis plays an important role in thyroid operations. Various endoscopic thyroid surgery approaches have been performed, and their application has recently been extended. We performed endoscopic thyroid surgeries via a breast approach since 1999. Herein, we evaluate the safety of this approach and identify the outcomes for differentiated thyroid carcinoma.

Methods: A total of 452 consecutive patients with thyroid and parathyroid disease underwent endoscopic thyroidectomy via a breast approach at Uijeongbu St. Mary's Hospital between November 1999 and December 2012. The inclusion criteria for endoscopic thyroidectomy included a benign tumour less than 4 cm in diameter, malignant thyroid nodules less than 2 cm, and no evidence of lymph node metastasis or local invasion. We analysed the clinicopathologic data and surgical factors of this approach.

Results: The mean age of the patients was 38.4 ± 10.6 years (range 11-73 years). The mean tumour size was 2.12 ± 1.17 cm (range 0.1-4 cm). The final tumour pathologies included papillary carcinoma (n = 120), follicular carcinoma (n = 8), nodular hyperplasia (n = 266), follicular adenoma (n = 43), and Hüthle cell adenoma (n = 4). The mean postoperative hospital stay was 3.8 ± 1.3 days (range 1-17 days). Temporary and permanent hypoparathyroidism requiring calcium and vitamin D supplementation developed in 32 (7.1%) and 4 (0.9%) patients, respectively. Transient vocal cord paresis occurred in 20 (4.4%) patients.

Conclusions: For patients with benign and low-risk malignant thyroid disease, endoscopic thyroidectomy via a breast approach is a safe, feasible, and minimally invasive surgical method with minimal complications.

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Operator and assistant positions during endoscopic thyroidectomy via a breast approach.
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Figure 1: Operator and assistant positions during endoscopic thyroidectomy via a breast approach.

Mentions: All patients were prepared for endoscopic thyroidectomy under general anaesthesia. After the patient was placed in a supine position, a pillow was placed beneath the shoulder to extend the head and neck. The operator and scope assistant stood on the right side of the patient, the first assistant stood on the left side of the patient, and the monitors were placed on both sides of the patient (Figure 1). To facilitate dissection and reduce bleeding, approximately 50 ml of saline solution (including 1 ml epinephrine and 20 ml bupivacaine) was injected into the subcutaneous layer of the anterior chest and the subplatysmal space in the neck. A 10-mm incision was made on the upper edge of the areola on the right side, a 5-mm incision was made on the upper edge of the areola on the left side, a 5-mm incision was made in the right parasternal region, and a 3-mm incision was made in the right axillary area (Figure 2). Initially, the flaps were dissected bluntly with a glass rod bar. After the blunt dissection, ports were inserted through each incision. Carbon dioxide gas was injected with a pressure of 6 mmHg. A 30-degree 5-mm rigid endoscope (Olympus, Tokyo, Japan) was inserted through the trocar in the right parasternal region. To create adequate working space, an additional dissection was performed with endoscopic shears and hooks (ENDOPATH Probe Plus II, Ethicon Endo-Surgery, Inc., Guaynabo, Puerto Rico, USA) by electrical cauterization. The working space was extended from the anterior chest to the thyroid cartilage level and laterally to the medial edge of each of the sternocleidomastoid muscles. After the extension of the flap, a midline division was made between the strap muscle from the thyroid cartilage to the sternal notch (Figure 3). Ultrasonic shears (Harmonic ACE, Ethicon Endo-Surgery, Inc., Guaynabo, Puerto Rico, USA) were then used to expose and dissect the thyroid gland from the inferior pole. The inferior thyroid vessel and the isthmus of the thyroid gland were divided using ultrasonic shears. After a careful dissection of the inferolateral aspects of the thyroid gland, the recurrent laryngeal nerve and the inferior parathyroid gland were identified (Figure 4), and the inferior thyroidal artery and the middle thyroidal vein were identified and divided. The superior pole of the gland was dissected, and the superior thyroid vessel was divided with ultrasonic shears. After the recurrent laryngeal nerve was identified, the thyroid gland was separated from the trachea and Berry’s ligament was carefully divided. After being placed in an endo-bag (Sejong Medical, Seoul, Korea), the specimen was pulled out through the endoscope port site. A frozen section of the specimen was examined intraoperatively for pathologic confirmation. The cavity was cleaned with a saline solution before a meticulous haemostasis was performed. The strap muscles were approximated with an absorbable suture. A 100-cc Jackson-Pratt drainage tube was left in the operative bed through the endoscope port site.


Endoscopic thyroid surgery via a breast approach: a single institution's experiences.

Kim YS, Joo KH, Park SC, Kim KH, Ahn CH, Kim JS - BMC Surg (2014)

Operator and assistant positions during endoscopic thyroidectomy via a breast approach.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4127080&req=5

Figure 1: Operator and assistant positions during endoscopic thyroidectomy via a breast approach.
Mentions: All patients were prepared for endoscopic thyroidectomy under general anaesthesia. After the patient was placed in a supine position, a pillow was placed beneath the shoulder to extend the head and neck. The operator and scope assistant stood on the right side of the patient, the first assistant stood on the left side of the patient, and the monitors were placed on both sides of the patient (Figure 1). To facilitate dissection and reduce bleeding, approximately 50 ml of saline solution (including 1 ml epinephrine and 20 ml bupivacaine) was injected into the subcutaneous layer of the anterior chest and the subplatysmal space in the neck. A 10-mm incision was made on the upper edge of the areola on the right side, a 5-mm incision was made on the upper edge of the areola on the left side, a 5-mm incision was made in the right parasternal region, and a 3-mm incision was made in the right axillary area (Figure 2). Initially, the flaps were dissected bluntly with a glass rod bar. After the blunt dissection, ports were inserted through each incision. Carbon dioxide gas was injected with a pressure of 6 mmHg. A 30-degree 5-mm rigid endoscope (Olympus, Tokyo, Japan) was inserted through the trocar in the right parasternal region. To create adequate working space, an additional dissection was performed with endoscopic shears and hooks (ENDOPATH Probe Plus II, Ethicon Endo-Surgery, Inc., Guaynabo, Puerto Rico, USA) by electrical cauterization. The working space was extended from the anterior chest to the thyroid cartilage level and laterally to the medial edge of each of the sternocleidomastoid muscles. After the extension of the flap, a midline division was made between the strap muscle from the thyroid cartilage to the sternal notch (Figure 3). Ultrasonic shears (Harmonic ACE, Ethicon Endo-Surgery, Inc., Guaynabo, Puerto Rico, USA) were then used to expose and dissect the thyroid gland from the inferior pole. The inferior thyroid vessel and the isthmus of the thyroid gland were divided using ultrasonic shears. After a careful dissection of the inferolateral aspects of the thyroid gland, the recurrent laryngeal nerve and the inferior parathyroid gland were identified (Figure 4), and the inferior thyroidal artery and the middle thyroidal vein were identified and divided. The superior pole of the gland was dissected, and the superior thyroid vessel was divided with ultrasonic shears. After the recurrent laryngeal nerve was identified, the thyroid gland was separated from the trachea and Berry’s ligament was carefully divided. After being placed in an endo-bag (Sejong Medical, Seoul, Korea), the specimen was pulled out through the endoscope port site. A frozen section of the specimen was examined intraoperatively for pathologic confirmation. The cavity was cleaned with a saline solution before a meticulous haemostasis was performed. The strap muscles were approximated with an absorbable suture. A 100-cc Jackson-Pratt drainage tube was left in the operative bed through the endoscope port site.

Bottom Line: Temporary and permanent hypoparathyroidism requiring calcium and vitamin D supplementation developed in 32 (7.1%) and 4 (0.9%) patients, respectively.Transient vocal cord paresis occurred in 20 (4.4%) patients.For patients with benign and low-risk malignant thyroid disease, endoscopic thyroidectomy via a breast approach is a safe, feasible, and minimally invasive surgical method with minimal complications.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Surgery, Uijeongbu St, Mary's Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu, Korea. drbreast@catholic.ac.kr.

ABSTRACT

Background: Thyroid carcinoma in young women is rapidly increasing, and cosmesis plays an important role in thyroid operations. Various endoscopic thyroid surgery approaches have been performed, and their application has recently been extended. We performed endoscopic thyroid surgeries via a breast approach since 1999. Herein, we evaluate the safety of this approach and identify the outcomes for differentiated thyroid carcinoma.

Methods: A total of 452 consecutive patients with thyroid and parathyroid disease underwent endoscopic thyroidectomy via a breast approach at Uijeongbu St. Mary's Hospital between November 1999 and December 2012. The inclusion criteria for endoscopic thyroidectomy included a benign tumour less than 4 cm in diameter, malignant thyroid nodules less than 2 cm, and no evidence of lymph node metastasis or local invasion. We analysed the clinicopathologic data and surgical factors of this approach.

Results: The mean age of the patients was 38.4 ± 10.6 years (range 11-73 years). The mean tumour size was 2.12 ± 1.17 cm (range 0.1-4 cm). The final tumour pathologies included papillary carcinoma (n = 120), follicular carcinoma (n = 8), nodular hyperplasia (n = 266), follicular adenoma (n = 43), and Hüthle cell adenoma (n = 4). The mean postoperative hospital stay was 3.8 ± 1.3 days (range 1-17 days). Temporary and permanent hypoparathyroidism requiring calcium and vitamin D supplementation developed in 32 (7.1%) and 4 (0.9%) patients, respectively. Transient vocal cord paresis occurred in 20 (4.4%) patients.

Conclusions: For patients with benign and low-risk malignant thyroid disease, endoscopic thyroidectomy via a breast approach is a safe, feasible, and minimally invasive surgical method with minimal complications.

Show MeSH
Related in: MedlinePlus