Endoscopic Thyroid Lobectomy Research Articles

Effects of endoscopic lobectomy and conventional lobectomy on psychological and sleep quality in patients with papillary thyroid microcarcinoma-a prospective observational study.

Both endoscopic thyroid lobectomy and conventional thyroid lobectomy are effective modalities for treating papillary thyroid microcarcinoma (PTMC). However, their respective psychological and sleep quality ramifications in patients remain largely unexplored. Patients diagnosed with PTMC who underwent thyroid lobectomy at our institution between July 15, 2021, and July 15, 2022, were prospectively recruited. Psychological distress and sleep quality were assessed at five intervals (hospital admission, hospital discharge, and 1, 3, and 6 months posttreatment) utilizing four validated scales. The PTMC patients who completed the questionnaires diligently were subsequently categorized into either the endoscopic thyroid lobectomy group (trial group) or the conventional thyroid lobectomy group (control group). A propensity score matching (PSM) cohort was then established to examine longitudinal and cross-sectional alterations in psychological parameters. Out of 602 eligible PTMC patients, 560 individuals completed all the questionnaires diligently during the follow-up period (response rate: 93.02%). This cohort comprised 176 patients (31.43%) who underwent endoscopic thyroid lobectomy and 384 patients (68.57%) who underwent conventional thyroid lobectomy. Following PSM, a comprehensive set of 176 matched patient pairs was successfully established. Both groups of patients exhibited a decline in sleep quality throughout the 6-month postoperative follow-up period; however, patients in the control group experienced concomitant elevation in anxiety levels. The PSQI scores of patients in the control group were markedly higher than those in the trial group across all follow-up time points, whereas the HAMA, HADS, and HEI scale scores did not significantly differ between the two groups. In terms of sleep quality and psychological well-being, endoscopic thyroid lobectomy is superior to conventional thyroid lobectomy for PTMC patients.

A novel anatomy-based five-settlement method for endoscopic thyroid lobectomy and ipsilateral central compartment neck dissection via gasless unilateral axillary approach: a preliminary report.

Endoscopic thyroidectomy (ET) via gasless unilateral axillary (GUA) approach has been widely implemented worldwide. Based on our concept of mesothyroid excision in open surgery, we proposed a novel anatomy-based five-settlement method in ET via the GUA approach. This preliminary report aimed to explore the efficacy and safety of this method in patients with papillary thyroid carcinoma (PTC). PTC patients who underwent endoscopic ET and unilateral central compartment neck dissection (CCND) via GUA approach with the five-settlement method at the Department of General Surgery, Nanfang Hospital, Southern Medical University from March 2020 to December 2021 were retrospectively collected. The data included general clinicopathological characteristics, surgical information (including duration, complication, and clinicopathological features), and hospital stay information, and other medical records were documented. In total, 521 patients underwent lobectomy and CCND under the GUA approach with the five-settlement method. The mean number of lymph nodes yielded (LNY) and positive lymph nodes (PLN) was 5.7 ± 4.3 (range, 1-30) and 1.0 ± 1.8 (range, 0-12), respectively. The incidence of transient recurrent laryngeal nerve injury was 1.1%. Chyle leakage and Horner's syndrome respectively occurred in one patient (0.2%). Five (0.9%) patients developed a hematoma. No severe complications or conversion to open surgery have occurred. The five-settlement method could be implemented safely and efficiently in ET+CCND via the GUA approach in selected PTC patients.

Evaluation of voice function after BABA robotic thyroid lobectomy: A comparative analysis with endoscopic thyroid lobectomy

The purpose of this study was to compare the effect of robotic thyroid lobectomy via Bilateral Axlio-Breast Approach (BABA) and endoscopic thyroid lobectomy on the voice function. A total of 125 patients with thyroid cancer from March 2021 to July 2022 were divided into the robotic thyroid lobectomy group and the endoscopic thyroid lobectomy group. Acoustic index and voice handicap index (VHI-10) were compared between the 2 groups before and after (1 week, 1 month, 3 month) the surgery. In the robotic group, VHI-10 score was not significantly different before and after the surgery. In the endoscopic group, VHI-10 score after the surgery was significantly higher than that before the surgery. In the endoscopic group, the fundamental frequency (F0) declined significantly 1 week and 1 month after the surgery compared with that before the surgery. One week after surgery, F0 in the endoscopic group was (197.91 ± 24.15) Hz, which was significantly lower than that (206.77 ± 20.13) Hz in the robotic group. In the robotic group, there was no obvious decline in F0 and MPT in each follow-up period after surgery compared with those before surgery. In the endoscopic group, MPT declined significantly 1 week after the surgery compared with that before surgery. One week after surgery, MPT in the endoscopic group was (13.02 ± 9.28) s, which was significantly lower than that (17.55 ± 9.25) s in the robotic groups. There were no significant differences in Shimmer, Jitter, DSI and NHR during all postoperative follow-up periods compared with those before surgery in both groups. The voice function of robotic thyroid lobectomy via BABA is superior to endoscopic thyroid lobectomy.

Comparison of quality of life and cosmetic result between open and transaxillary endoscopic thyroid lobectomy for papillary thyroid microcarcinoma survivors: A single-center prospective cohort study.

Transaxillary endoscopic thyroidectomy has been introduced to achieve better cosmetic outcomes. However, the benefits of this technology on the patients' health-related quality of life (HRQoL) remain unclear. We aimed to investigate whether transaxillary endoscopic lobectomy is comparable to conventional open lobectomy in terms of QOL and cosmetic results in order to provide more evidence for establishing appropriate clinical decisions. Between August 2019 and May 2020, transaxillary endoscopic lobectomy and conventional open lobectomy were performed in 73 and 99 patients with papillary thyroid microcarcinoma, respectively. HRQoL was assessed at 1, 3, 6, and 12months after surgery using the Thyroid Cancer-Specific Quality of Life Questionnaire. The cosmetic outcomes were assessed 12months after surgery using the Patient and Observer Scar Assessment Scale (POSAS). No significant difference was observed in the surgical results between the two groups. However, the data showed that the average operative time and postoperative hospital stay of the transaxillary group were longer than those of the open group (p < 0.001). Both groups showed similar changes in the QOL scores over time. However, the transaxillary group had fewer complaints of the throat or oral problems at 1 month postoperatively than the open group (p < 0.001). During the follow-up, the cosmetic results of scars in the transaxillary group were significantly better than those in the open group (p < 0.05). Patients who underwent transaxillary endoscopic lobectomy had higher overall satisfaction with their scar appearance, determined using POSAS, at 12months postoperatively. The current findings suggest that transaxillary endoscopic lobectomy may offer better cosmetic and HRQoL outcomes.

Transoral endoscopic thyroidectomy using a self-retaining retractor as an alternative to carbon dioxide gas insufflation: A comparative analysis of 131 cases

Although transoral endoscopic thyroid surgery affords several advantages, the use of carbon dioxide (CO2) gas to create and maintain the working space may cause complications such as subcutaneous emphysema and a CO2 embolism. We have used a self-retaining retractor as an alternative to CO2 gas insufflation for some time; we here report its feasibility and safety. We reviewed the medical records of 131 patients who underwent transoral endoscopic thyroid lobectomy; we compared the “CO2 group” and the “retractor” group. All thyroid tumors were completely removed with negative surgical margins. No major complication occurred in the retractor group. Two major events occurred in the CO2 group: one case of permanent vocal cord palsy and one CO2 embolism. Significant subcutaneous emphysema of the neck and chest were noted in 17.7% of CO2 group patients, but in no retractor group patient. Wound infection occurred in one patient in each group but improved after appropriate management. The total operation times from incision to suture did not differ significantly between the two groups (p = 0.514). Transoral endoscopic thyroidectomy using a self-retaining retractor as an alternative to CO2 gas insufflation is feasible and safe. The superiority of transoral endoscopic thyroidectomy would be emphasized by avoiding CO2 gas insufflation, thus eliminating the risk of CO2 gas-related complications.

Remote Access Thyroid Surgery: A Review of Literature.

Since the first description of endoscopic thyroid lobectomy in 1997, a variety of techniques have been developed to avoid the visible cervical scar conventionally been associated with thyroidectomy. These "remote access" approaches, which typically use either endoscopic or robotic instrumentation, have successfully avoided the anterior neck scar, which has a measurable impact on the patient's quality of life (Graves and Suh Surgery 168(5):845-850, 2020; Sakorafas World J Surg 34(8):1793-1804, 2010). The main advantage of these techniques is better cosmesis compared to conventional transcervical approaches (Graves and Suh Surgery 168(5):845-850, 2020) However, these techniques have failed to gain widespread acceptance in the surgical community because of the technical challenges, scepticism about oncological safety and cost factors. This review presents an overview of the various methods of remote access thyroid surgery (RATS) and also evaluates the selection criteria, oncological efficacy, training requirements and key advantages of this technique.

Endoscopic Thyroid Lobectomy: Our Early Experience at Lahore General Hospital, Lahore, Pakistan

Background Conventional Thyroid Lobectomy leaves an unpleasant neck scar. Endoscopic thyroidectomy was first applied by Huschner in 1997. Amongst the best endoscopic techniques is the one we use, referred to as the endoscopic axillary-breast-shoulder approach (ABSA) innovated by Dr. Trans Ngoc Luong. Objective To examine the safety, feasibility and cosmetic outcome of endoscopic thyroid lobectomy. Patients and Methods We performed endoscopic lobectomy in 20 patients at Lahore General Hospital (LGH) from 9th September 2016 to 31st Dec 2019. We adopted axillary-breast-shoulder approach. Inclusion criteria were age 18-45 years, solitary nodule less than 5 cm and benign FNAC. Exclusion criteria were multiple nodules, solitary nodule more than 5 cm, age more than 45years, malignant FNAC, recurrent goiter and co-morbid like DM, HTN, IHD, COPD. The parameters studied were the conversion rate, operative time, hospital stay, complications, cosmetic outcome and patient satisfaction. The results were analyzed to draw rational conclusion. Results Successful endoscopic lobectomy was performed in almost all cases with conversion to open in two cases. The median operative time was 100 minutes. No preoperative injury was inflicted. One case sustained minor skin burns which healed without any residual scar. One patient developed full thickness skin burn and one patient had seroma. All patients were discharged on first postoperative day. Excellent cosmetic outcome achieved in all patients leading to their optimum satisfaction. Conclusion Endoscopic thyroid lobectomy is a safe and feasible procedure with satisfactory cosmetic outcome for benign solitary thyroid nodules in selected patients.

Transaxillary endoscopic thyroid lobectomy: gas insufflation versus gasless technique.

The objective of this study is to compare the clinical outcomes between gas insufflation and gasless techniques used in transaxillary endoscopic thyroid lobectomy. Data of patients who underwent transaxillary endoscopic thyroid lobectomy from June 2011 to August 2019 were reviewed. All surgeries were performed by one experienced surgeon. The patients were divided into two groups according to surgical technique as gas insufflation or gasless technique. The clinical outcomes such as complications, postoperative pain score assessed using VAS, length of hospital stay, and presence of iatrogenic ectopic thyroid tissue were compared between the two groups. During the study period, a total of 60 patients underwent transaxillary endoscopic thyroid lobectomy: 38 patients via gas insufflation and 22 using the gasless technique. The basic characteristic features of the patients and their diseases were not significantly different between the two groups. Gas insufflation yielded significantly better surgical outcomes than the gasless technique: shorter operative time (209.3 ± 63.1min. vs. 267.6 ± 66.0min.; P = 0.001), less estimated blood loss [10.0 (5.0, 20.0) mL vs. 30.0 (16.2, 50.0) mL; P < 0.001], less drainage content [10.0 (0.0, 70.0) mL vs. 81.5 (74.2, 104.5) mL; P < 0.001], and shorter hospital stay [1.5 (1.1, 2.0) days vs. 1.8 (1.5, 2.5) days; P = 0.032]. Regarding postoperative pain, there was no statistically significant difference in visual analog scales (VAS) at 24 and 48h. Finally, no evidence of iatrogenic ectopic thyroid tissue was found in both groups. Compared to the gasless technique, the gas insufflation technique provided shorter operative time, less estimated blood loss, less drainage content, and shorter hospital stay. Moreover, there were comparable outcomes regarding postoperative pain, complications and iatrogenic ectopic thyroid tissue.

Endoscopic thyroid lobectomy vs Conventional open thyroid lobectomy.

Background and Objective:Surgical managements for these suspicious nontoxic swellings requires open conventional method of thyroidectomy by neck incisions that can result in prominent scars and immediate risk usually hemorrhage. However new technological innovations came into practiced that include video assisted minimal invasive endoscopy by axillo-breast approach that gives very promising results with excellent cosmesis. In this study, we compared conventional open surgery with minimal invasive endoscopic techniques and associate various complaints and complications that were encountered in surgery.Methods:Sixty patients were enrolled in this comparative study. It was conducted from period February 2018 to February 2019. The patients were randomized alternatively in two groups. Group-I patients underwent conventional lobectomy while Group-II patients were operated endoscopically, Patients having nodules less than 3cm and Thy 1 and 2 were included in this study. Patient having nodules greater than 3cm, Multinodular goiter, recurrent nodule and Thy 3-6 were excluded from the study.Results:Patients who underwent endoscopic lobectomy were much more satisfied about scar marks whereas some developed post-operative complications. It included hoarseness of voice in Three (13.62%) patients, two patients developed seroma (9.08%), three patients (13.62%) erythema, whereas no postoperative complications were seen in patients who underwent open thyroid lobectomy. No signs of hypocalcemia noted in both approaches.Conclusions:The complications with endoscopic approaches are higher but they are minor and resolved spontaneously within maximum period of six weeks. However scar mark satisfaction was much higher in endoscopic lobectomy group.

Learning Curve for Transoral Endoscopic Thyroid Lobectomy.

Objective To define the learning curve for transoral endoscopic thyroidectomy via the vestibular approach (TOETVA). Study Design Case series with planned data collection. Setting Tertiary care academic hospital. Subjects and Methods Included patients were those who met the 2015 American Thyroid Association guidelines for lobectomy and our group's previously documented indications for TOETVA. Operative time (incision to closure) was used as a surrogate for procedural proficiency and plotted as a function of case number to determine a learning curve. A simple moving average of operative time was then calculated, with the proficiency case defined as the case number where the slope of this curve changed. Demographic/characteristic data, outcomes, and complications were compared between the skill acquisition period (case 1 to proficiency case) and the proficiency period (remaining cases). A linear regression model was then used to calculate and compare the slopes of the skill acquisition and proficiency periods in the "operative time versus case number" plot. Results Thirty cases were attempted, with a procedural success rate of 29 of 30 (94%) and no incidence of permanent mental nerve or recurrent laryngeal nerve injury. The proficiency case was case 11. There was a statistically significant difference between the skill acquisition and proficiency periods in slopes of the linear regressions (-16.7 vs -0.3, respectively; P < .001) and median operative times (191 vs 119 minutes, P < .001). There was no difference in demographics, procedural success rate, or complication rate between the periods. Conclusions The learning curve for TOETVA was 11 cases for the surgeon evaluated in this series.

Endoscopic Thyroid Lobectomy via Axillary-Breast-Shoulder Approach versus Open Thyroid Lobectomy

Introduction: The aim of the study was to compare the feasibility and safety of endoscopic thyroid lobectomy via axillary-breast-shoulder approach (ET via ABS) with a conventional open thyroid lobectomy (OT). Methods: From November 2014 to December 2015, 20 patients with unilateral benign thyroid nodules were treated with ET via ABS and another 20 patients were treated with an OT. We analyzed the clinical characteristics postoperative complications, pain, and patient satisfaction. Results: No statistically significant differences occurred between groups except the mean ages of the OT group and the ET via ABS group were 55 and 44 years, respectively (p = 0.015). The mean operative time was almost the same in both groups (116 min in the OT group and 114 min in the ET via ABS group). Blood loss was significantly higher in the OT group than in the ET via ABS group (p = 0.042) but postoperative drainage was detected more in the ET via ABS group (p < 0.001). Early postoperative pain was significantly less in the ET via ABS group (p = 0.026). The hospital stay was three days in OT group and four days in ET via ABS group (p = 0.909). Postoperative complications such as hematoma, hoarseness, dysphagia, and prolonged subcutaneous emphysema were detected only in the ET via ABS group but without statistical difference. More patients were “very satisfied” with the treatment in the ET via ABS group than in the OT group. Conclusion: The ET via ABS is as safe and effective as the OT for patients with unilateral thyroid nodules. With less early postoperative pain and higher patient satisfaction, this endoscopic thyroidectomy approach should be considered in patients who concern about cosmetic results.

Comparison of the breast and areola approaches for endoscopic thyroidectomy in patients with microcarcinoma.

The safety, advantages and disadvantages of thyroidectomy for microcarcinoma through the areola approach and breast approach were compared. Fifty patients diagnosed with thyroid microcarcinoma in our department from January 2014 to June 2015 were selected. The areola approach was carried out for 21 patients whereas the breast approach for 29 patients. Endoscopic thyroid lobectomy, isthmus resection and dissection of central group lymph nodes was performed. The clinical outcomes of the two surgical approaches were compared. Comparing operating time, blood loss during surgery, number of lymph node dissections, postoperative hospitalization time and surgical complications between the surgical approaches, there were no significant differences (P>0.05). Comparing patient satisfaction of cosmetic results from the incisions, the difference was statistically significant (P<0.05). Endoscopic thyroidectomy via areola approach and breast approach have equal curative effects for the treatment of thyroid microcarcinoma. However, the areola approach can achieve better cosmetic results and is a safe and ideal surgical method, that we recommend be widely used.

Comparison of quality of life between open and endoscopic thyroidectomy for papillary thyroid cancer

Recently, various endoscopic thyroidectomy techniques have been introduced for cosmetic purposes. However, few reports have compared the quality of life (QOL) between post-endoscopic thyroidectomy and post-conventional open thyroidectomy. In this study, we investigated whether endoscopic thyroidectomy was comparable to conventional open thyroidectomy with respect to QOL. Between January 2010 and September 2011, 75 patients underwent endoscopic thyroid lobectomy and 233 patients underwent conventional open thyroid lobectomy. The QOL was assessed preoperatively and at 1, 3, and 6 months postoperatively by using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30-question (EORTC-QLQ-C30) instruments. Both groups showed similar changes over time in most of the QOL scales. However, patients who underwent endoscopic thyroidectomy showed significantly greater improvement in emotional function at 1 month (p = .039) and physical function at 3 months (p = .032). However, the pain increased more in the patients who underwent endoscopic thyroidectomy at 1 month (p = .042). Current findings suggest that endoscopic thyroidectomy may offer more rapid recovery of emotional and physical function than open thyroidectomy. © 2015 Wiley Periodicals, Inc. Head Neck 38: E827-E831, 2016.

Endoscopic thyroid lobectomy using bilateral axillo-breast approach: Surgical techniques and outcomes

Aim The aim of the present study was to report our surgical technique and perioperative outcomes of endoscopic thyroid lobectomy using the bilateral axillo-breast approach (BABA). Patients and Methods We conducted a retrospective cohort analysis of prospectively-collected data on consecutive female patients who underwent BABA endoscopic unilateral thyroid lobectomy for indeterminate thyroid nodules. Results Between July 2012 and July 2014, 18 patients with a mean age of 37.9 ± 14.4 years received BABA endoscopic right (n = 12) and left (n = 6) thyroid lobectomy for nodules with atypia of undetermined significance (n = 7), follicular lesion of undetermined significance (n = 6) and follicular neoplasm (n = 5) in our unit. The mean nodule size was 23.6 ± 9.7 mm. All operations were successfully accomplished with no conversion to open procedures. The mean operating time was 155.9 ± 34.9 min. Intraoperative blood loss was negligible in all patients (below 10 mL). There was no postoperative haemorrhage, wound hematoma or iatrogenic parathyroid injury. Transient recurrent laryngeal nerve palsy occurred in one patient (5.6 per cent), whose condition completely recovered after 6 months. The mean hospital stay was 2.5 ± 0.7 days. At 6 months after surgery, the mean cosmetic satisfaction score was 94.4 ± 12.4 out of 100. Chronic anterior chest wall pain and chest wall paresthesia was only reported in one respective patient (5.6 per cent). Conclusion BABA is a feasible and cosmetically-excellent technique in performing endoscopic thyroid lobectomy. It should be recommended for eligible patients who have strong desire on cosmetic outcomes.

Cystic Medullary Thyroid Carcinoma: A Case of Undergoing Endoscopic Thyroid Lobectomy

Cystic Medullary Thyroid Carcinoma: A Case of Undergoing Endoscopic Thyroid Lobectomy

Cystic Medullary Thyroid Carcinoma: A Case of Undergoing Endoscopic Thyroid Lobectomy

Cystic Medullary Thyroid Carcinoma: A Case of Undergoing Endoscopic Thyroid Lobectomy

Endoscopic Completion Thyroidectomy by the Bilateral Axillo-Breast Approach

Bilateral axillo-breast approach (BABA) endoscopic thyroidectomy has been successfully used for various thyroid diseases, with an excellent cosmetic outcome. Patients with a confirmed thyroid malignancy on a permanent thyroid section after endoscopic thyroid lobectomy require completion thyroidectomy. Here, we sought to demonstrate the feasibility of endoscopic completion thyroidectomy by BABA. Between June, 2006 and February, 2009, 13 patients underwent endoscopic completion thyroidectomy by BABA for minimally invasive follicular thyroid and papillary thyroid carcinomas diagnosed after BABA endoscopic thyroid lobectomy. The median interval between thyroid lobectomy and completion thyroidectomy was 5.6 months (range, 4.2-28.2 mo). We used the same port sites (bilateral breast and axillary region) as were created at the initial operation. Flap adhesion was minimal. After identifying the remnant thyroid lobe, completion thyroidectomy was performed under full visualization of the thyroidal vessels, parathyroid glands, and recurrent laryngeal nerve. We performed 5 right and 8 left endoscopic completion thyroidectomies by BABA. The mean operation time was 109.3±23.3 minutes. There were no cases of open conversion. The resulting 6 (46.2%) cases of transient hypocalcemia resolved within 2 postoperative weeks and there were no cases of vocal cord palsy or wound infection. One patient had immediate postoperative breast flap bleeding that required cauterization. No patient had evidence of recurrence, as indicated by follow-up neck ultrasonography and serum thyroglobulin levels. The cosmetic outcomes were excellent and all patients were satisfied. BABA endoscopic thyroidectomy appears feasible and safe procedure for completion thyroidectomy, making it a viable technique for reapplication in cases of thyroid carcinoma diagnosed after endoscopic thyroid lobectomy.

Bilateral transaxillary endoscopic total thyroidectomy

Minimal-access thyroid surgery using various techniques is well described. The present study reviews our initial experience with total thyroidectomy using a robotic-assisted bilateral transaxillary endoscopic approach (R-BAEA) and a non-robotic-assisted bilateral transaxillary endoscopic approach (BAEA) to assess it's safety and feasibility. The study group was 13 consecutive patients who were candidates for total thyroidectomy with benign thyroid disease. Two young adult patients who were older than 20 years and 2 teenage patients who underwent a transaxillary endoscopic thyroid lobectomy were excluded from this study that was composed of 9 children. A detailed description of the surgical technique is provided. Eight patients were female and one was male. The mean age was 13.5 +/- 3.0 years. Two R-BAEAs and 7 BAEAs were performed. The initial diagnosis was Graves disease in all 9 cases. The mean operating time was 385 minutes (range, 364-407 minutes) for R-BAEA and 259 minutes (range, 135-385 minutes) for BAEA. The mean diameter of the resected specimens was 5.9 cm (range, 4.5-8.3 cm); the mean intraoperative blood loss was 15.0 mL (range, 10-30 mL). The recurrent laryngeal nerve and parathyroid glands were identified and preserved intact in all cases. No patients required conversion. There was one instance of postoperative wound erythema, and 2 patients experienced hypocalcemia that resolved spontaneously. Two patients with large glands experienced a transient postoperative hoarseness. The mean total postoperative morphine dose administered in the first 24 hours was 1.5 mg (range, 0-4 mg). Postoperative pain was minimal, and cosmetic results were considered excellent by all patients. All except one were discharged the day after surgery and returned immediately to normal activities. Total thyroidectomy using BAEA with or without robotic assistance is feasible and safe. The advantages of this approach are no cervical scar, no significant morbidity, less postoperative pain, and early return to normal activity compared with other published techniques.

Endoscopic transaxillary approach to the thyroid gland: our early experience

Thyroid nodules are a common occurrence in clinical practice today. Most nodules are benign and can be managed nonoperatively with careful medical follow-up. However surgical extirpation occasionally becomes necessary to exclude a malignant neoplastic process. Although the majority of surgically excised thyroid lesions are histologically benign, patients are traditionally left with a permanent transverse surgical scar in a highly visible area of the neck. From August 2003 to August 2005, we performed a transaxillary endoscopic thyroid lobectomy with isthmectomy in 32 patients. We used a 3-port technique with 5-mm trocars and surgical instrumentation. A 5-mm 45-degree angled endoscope was used for visualization during the procedure. The CO(2) insufflation pressure was set to 6-8 mmHg, and dissection was carried out using a 5-mm harmonic scalpel (Ethicon Endo-Surgery). All patients underwent successful completion of thyroid lobectomy and isthmectomy. No conversion to open operation was required in this series. The mean operating time was 138.5 min, and the mean blood loss was 36.4 ml. The recurrent laryngeal nerve was identified in each case, and there was no permanent injury to this structure. There were two cases of temporary hoarseness that resolved spontaneously. One patient in this series had to be returned to the operating room for evacuation of a postoperative hematoma from an active bleeding vessel on the surface of the pectoralis major muscle. All patients were discharged on the first postoperative day. Transaxillary endoscopic thyroidectomy is a safe and feasible alternative to the traditional open surgical approach in select patients requiring surgical removal of the thyroid gland. The resultant improved cosmetic outcome and enhanced operative visualization may offer a practicable alternative for select patients requiring surgical removal of the thyroid gland.

Endoscopic Lateral Approach Thyroid Lobectomy: Safe Evolution from Endoscopic Parathyroidectomy

Endoscopic thyroid surgery has been shown to be feasible. Most minimal access procedures have been performed via a midline approach. Based on our experience of more than 500 endoscopic parathyroidectomies via a lateral approach we have used the same method for thyroid lobectomy. We present our experience of endoscopic thyroid lobectomy via a lateral approach (ETLA) and review of the results over a 1-year period (2004). Inclusion criteria for ETLA were (1) solitary nodule with atypical/suspicious fine-needle biopsy (FNB) or solitary toxic nodule; (2) lesions with a diameter of < 3 cm. Patients with a history of previous neck surgery or radiation exposure were excluded. All patients underwent postoperative vocal cord checks and plasma calcium evaluation. A total of 742 thyroid procedures were performed during 2004. Among them, 38 patients (5.1%) underwent ETLA. Indications for surgery were suspicious FNB results (36 patients) and a toxic nodule (2 patients). Mean nodule size was 19.2 mm. Mean +/- SD operating time was 102 +/- 27 minutes. All recurrent laryngeal nerves were identified (including one that was nonrecurrent). Of the 38 patients, the superior parathyroid gland was identified in 36 and the inferior parathyroid gland in 33. There were two conversions due to difficulty with the dissection. Two operations were converted because malignancy was diagnosed on frozen section examination. Two patients underwent a delayed completion thyroidectomy when definitive histology necessitated it. There were no permanent operative complications, and all patients were discharged on the first postoperative day. ETLA offers excellent intraoperative visualization of the vital structures and is a safe alternative to conventional thyroid lobectomy in selected cases.