Transaxillary hemithyroidectomy and parathyroidectomy: mastering the technique

Abstract

Background. The relevance of endoscopic interventions on the thyroid and parathyroid glands is beyond doubt, and this explains the interest in this promising choice of surgical approach both among surgeons and patients who want to avoid a scar on the neck.Aim. To evaluate the first results of own endoscopic interventions in patients with diseases of the thyroid and parathyroid glands.Materials and methods. In the Research Institute of KCH N 1 named after prof. S.V. Ochapovsky from December 2020 to April 2022, 23 hemithyroidectomies and 8 paraadenomectomies were performed using endoscopic techniques for benign neoplasms of the thyroid and parathyroid glands. All patients in the preoperative period underwent ultrasound, TAPB + CI (for thyroid pathology), and the hormonal background was studied. Indications for endoscopic hemithyroidectomy in 18 cases were colloid goiter, in 5 cases — follicular adenoma. The indication for endoscopic paraadenomectomy in all cases was primary hyperparathyroidism. We used endoscopic three-port axillary-mammary gas access. Under the ETN, an incision was made along the outer edge of the pectoralis major muscle (m. pectoralis major). Carbon dioxide was injected into the pancreas using a Verish needle. A 5 mm port was inserted along the edge of the areola. Another 10 mm trocar was installed at the attachment points (m. pectoralis major).Results. The average operation time was 190.4 minutes for endoscopic hemithyroidectomy and 78.6 minutes for endoscopic paraadenomectomy. With the increase in the number of performed operations, there was a decrease in the duration of surgical interventions. In two cases in patients after hemithyroidectomy, seromas up to 20 ml in volume were noted in the postoperative period, which required puncture interventions (once).Conclusion. Endoscopic interventions on the thyroid and parathyroid glands from axillary access are a safe method of surgical intervention, and the cosmetic result is an indisputable advantage of this method.