Trans-areola Single-incision Endoscopic Thyroidectomy

Abstract

Single-incision laparoscopic surgery has been successfully applied to abdominal general and bariatric procedures with advantages of less morbidity over conventional laparoendoscopic surgery. Minimally invasive and laparoendoscopic procedures have also recently been expanded for thyroid surgery. We report the first case of trans-areola single-incision endoscopic thyroidectomy (TASIET) in the world. A 20-year-old female patient presented with a solitary left thyroid nodule. Single-incision endoscopic thyroidectomy was successfully performed by an incision bordering the left breast areola. Two adjacent 10 mm and 5 mm trocars were used for the placement of a 10 mm videoscope (30 degrees) and ultrasonic shears, respectively. A single narrow tunnel was first created from the areola to the neck, and the oval space between platysma and strap muscles in the anterior neck was dissected. Left lobectomy was accomplished after the strap muscles and thyroid were suspended with transcutaneous sutures. The specimen was removed in a self-made plastic bag through the 10 mm incision. Anatomical delineation of the left recurrent laryngeal nerve and parathyroid glands were satisfactory. Blood loss was less than 20 mL. The total operative time was 156 minutes. The patient required no administration of analgesics and was discharged postoperatively without complications. After 3 months follow-up, cosmetic outcome was excellent with a small periareaolar incision and no cervical scar. Pathology revealed a benign follicular adenoma. Our first TASIET is feasible with excellent cosmesis and advantages of minimally access surgery. Ongoing studies with TASIET are in progress to define the optimal indications and patient selection criteria for this new thyroidectomy technique.