Endoscopic Retro‐auricular Thyroidectomy: A Preclinical Feasibility Study in Three Cadavers

Abstract

Objectives: A number of remote-access thyroidectomy techniques with the assistance of endoscopic or robotic technology have been described. Most gasless endoscopic thyroidectomies require additional incision on the chest or mammary areola for instrumentation. Recently, Terris DJ et al. developed a novel remote-access robotic facelift thyroidectomy technique. We aimed to evaluate the preclinical feasibility of endoscope-assisted thyroidectomy and central neck dissection via retro-auricular single incision in three cadavers. Methods: Three fresh, unembalmed human cadavers were used. A 5-mm, 30-degree rigid telescope, endoscopic instruments, and a Harmonic scalpel were used. Working space was created through the retro-auricular incision. Surgical procedures included the identification and ligation of the superior thyroid pedicle, peri-thyroid fascia dissection, dissection of the inferior pole, identification of the recurrent laryngeal nerve (RLN), dissection near the Berry ligament, and isthmusectomy. Results: We successfully performed total thyroidectomy and central neck dissection in all three cadavers. In all thyroidectomies, the RLN and superior or inferior parathyroid glands were preserved. There was no tracheal or esophageal injury. To confirm surgical completeness after thyroidectomy and central neck dissection, we analyzed the specimen to determine if there was violation of the thyroid capsule, and we reviewed the surgical field to check for remnant thyroid tissue. There was neither capsule injury in the specimen nor remnant thyroid tissue in the surgical field. The working space was adequate for the instrumentation, and no additional incision was needed. Conclusions: Our study demonstrates the feasibility of endoscope-assisted thyroidectomy using a gasless, retro-auricular single approach that results in safety, surgical completeness and sufficient access.