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Comparison of Conventional Open Thyroidectomy and Endoscopic Thyroidectomy via Breast Approach for Papillary Thyroid Carcinoma.

Tan Z, Gu J, Han Q, Wang W, Wang K, Ge M, Shang J - Int J Endocrinol (2015)

Bottom Line: The two groups were compared in terms of patient characteristics, perioperative clinical results, and postoperative complication.Results.Conclusions.

View Article: PubMed Central - PubMed

Affiliation: Department of Head and Neck Surgery, Zhejiang Cancer Hospital, Hangzhou 310022, China.

ABSTRACT
Purpose. The aim of this study was to evaluate the feasibility of endoscopic thyroidectomy via breast approach for papillary thyroid carcinoma (PTC). Methods. Between March 2008 and March 2013, 34 patients with PTC received endoscopic thyroidectomy (endo group) and 30 patients received conventional open thyroidectomy (open group). Patients in two groups underwent ipsilateral central compartment node dissection. The two groups were compared in terms of patient characteristics, perioperative clinical results, and postoperative complication. Results. The rates of lymph node metastasis in endo group and open group were 23.5% (8/34) and 13.3% (4/30), respectively, without statistically significant difference (P = 0.351). The mean number of lymph nodes dissected was 2.4 ± 2.9 in endoscopic group and 2.2 ± 1.9 in open group (P = 0.774). During the follow-up period, there was no recurrence or metastatic patients in two groups. All patients received the excellent cosmetic results in endo group, while 25 patients were satisfied with the cosmetic result and 5 were unsatisfied in the open group. Conclusions. The efficacy of endoscopic thyroidectomy via breast approach could be comparable to conventional open thyroidectomy in selected patients with PTC.

No MeSH data available.


Related in: MedlinePlus

(a) Two incisions for the main and auxiliary operation ports (black arrow); the incision for laparoscope (white arrow); (b) external view after positioning the trocars.
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fig1: (a) Two incisions for the main and auxiliary operation ports (black arrow); the incision for laparoscope (white arrow); (b) external view after positioning the trocars.

Mentions: Endoscopic procedure was as follows. (1) Position and anesthesia: patients were placed in a supine position while under general anesthesia. The neck was slightly extended. (2) Establishing subcutaneous working space: the designed working space was injected with 200–350 mL of “inflation liquid” (consisting of 1 mg adrenaline mixed with 500 mL saline) in the subcutaneous space. A 10 mm straight incision was made outside 2 cm of sternal partial lateral at the level of nipple, which could reduce the scar compared with the sternal median incision. A subcutaneous separation stick was used to separate the skin through the incision resulting in fanning out from the deep layer of the superficial fascia toward the suprasternal fossa for building an observation tube (trocar) tunnel for endoscope. Each of 5 mm incisions was made at the bilateral areola to establish the main and auxiliary operation ports for ultrasonic scalpel and grasper (Figures 1(a) and 1(b)). Then the subcutaneous loose connective tissue was separated directly by ultrasonic scalpel. (3) Separating and resecting thyroid tissue: cervical linea alba was dissected and the thyroid anterior muscles were separated by ultrasonic scalpel, and then the anterior cervical muscle group was retracted with suture to expose the thyroid tissue. The lower pole of thyroid was exposed through blunt dissection, and then the inferior thyroid arteries and veins were resected. The lobe was retracted superiorly and medially, and the middle thyroid vein and Berry's ligament were cut with ultrasonic scalpel. The recurrent laryngeal nerve (RLN) was exposed by blunt dissection to reveal its position and course. Subsequently, the superior thyroid arteries were exposed and resected after retracting the lobe inferiorly. Finally, the lobe was dissected from the trachea. (4) The resected specimens were sent for frozen section; if confirmed to be PTC, ipsilateral central compartment node dissection was performed routinely.


Comparison of Conventional Open Thyroidectomy and Endoscopic Thyroidectomy via Breast Approach for Papillary Thyroid Carcinoma.

Tan Z, Gu J, Han Q, Wang W, Wang K, Ge M, Shang J - Int J Endocrinol (2015)

(a) Two incisions for the main and auxiliary operation ports (black arrow); the incision for laparoscope (white arrow); (b) external view after positioning the trocars.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4563104&req=5

fig1: (a) Two incisions for the main and auxiliary operation ports (black arrow); the incision for laparoscope (white arrow); (b) external view after positioning the trocars.
Mentions: Endoscopic procedure was as follows. (1) Position and anesthesia: patients were placed in a supine position while under general anesthesia. The neck was slightly extended. (2) Establishing subcutaneous working space: the designed working space was injected with 200–350 mL of “inflation liquid” (consisting of 1 mg adrenaline mixed with 500 mL saline) in the subcutaneous space. A 10 mm straight incision was made outside 2 cm of sternal partial lateral at the level of nipple, which could reduce the scar compared with the sternal median incision. A subcutaneous separation stick was used to separate the skin through the incision resulting in fanning out from the deep layer of the superficial fascia toward the suprasternal fossa for building an observation tube (trocar) tunnel for endoscope. Each of 5 mm incisions was made at the bilateral areola to establish the main and auxiliary operation ports for ultrasonic scalpel and grasper (Figures 1(a) and 1(b)). Then the subcutaneous loose connective tissue was separated directly by ultrasonic scalpel. (3) Separating and resecting thyroid tissue: cervical linea alba was dissected and the thyroid anterior muscles were separated by ultrasonic scalpel, and then the anterior cervical muscle group was retracted with suture to expose the thyroid tissue. The lower pole of thyroid was exposed through blunt dissection, and then the inferior thyroid arteries and veins were resected. The lobe was retracted superiorly and medially, and the middle thyroid vein and Berry's ligament were cut with ultrasonic scalpel. The recurrent laryngeal nerve (RLN) was exposed by blunt dissection to reveal its position and course. Subsequently, the superior thyroid arteries were exposed and resected after retracting the lobe inferiorly. Finally, the lobe was dissected from the trachea. (4) The resected specimens were sent for frozen section; if confirmed to be PTC, ipsilateral central compartment node dissection was performed routinely.

Bottom Line: The two groups were compared in terms of patient characteristics, perioperative clinical results, and postoperative complication.Results.Conclusions.

View Article: PubMed Central - PubMed

Affiliation: Department of Head and Neck Surgery, Zhejiang Cancer Hospital, Hangzhou 310022, China.

ABSTRACT
Purpose. The aim of this study was to evaluate the feasibility of endoscopic thyroidectomy via breast approach for papillary thyroid carcinoma (PTC). Methods. Between March 2008 and March 2013, 34 patients with PTC received endoscopic thyroidectomy (endo group) and 30 patients received conventional open thyroidectomy (open group). Patients in two groups underwent ipsilateral central compartment node dissection. The two groups were compared in terms of patient characteristics, perioperative clinical results, and postoperative complication. Results. The rates of lymph node metastasis in endo group and open group were 23.5% (8/34) and 13.3% (4/30), respectively, without statistically significant difference (P = 0.351). The mean number of lymph nodes dissected was 2.4 ± 2.9 in endoscopic group and 2.2 ± 1.9 in open group (P = 0.774). During the follow-up period, there was no recurrence or metastatic patients in two groups. All patients received the excellent cosmetic results in endo group, while 25 patients were satisfied with the cosmetic result and 5 were unsatisfied in the open group. Conclusions. The efficacy of endoscopic thyroidectomy via breast approach could be comparable to conventional open thyroidectomy in selected patients with PTC.

No MeSH data available.


Related in: MedlinePlus