Endoscopic Thyroidectomy Group Research Articles

Comparison of gasless transaxillary endoscopic thyroidectomy, endoscopic thyroidectomy via areola approach and conventional open thyroidectomy in patients with unilateral papillary thyroid carcinoma

BackgroundGasless transaxillary endoscopic thyroidectomy (GTET) and endoscopic thyroidectomy via the areola approach (ETA) have emerged as minimally invasive surgical techniques for managing papillary thyroid carcinoma (PTC). This study aimed to assess the surgical efficacy of endoscopic thyroidectomy (ET) as compared to conventional open thyroidectomy (COT) in PTC patients.MethodsBetween 2020 and 2022, 571 PTC patients underwent unilateral thyroidectomy accompanied by ipsilateral central lymph node dissection. This cohort comprised 72 patients who underwent GTET, 105 ETA, and 394 COT. The analysis encompassed a comprehensive examination of patient clinicopathologic characteristics and postoperative complaints. Furthermore, the learning curve of GTET was evaluated using the cumulative summation (CUSUM) method.ResultsPatients in the ET group exhibited a lower mean age and a higher proportion of female individuals. Operation time in the ET group was significantly longer. No significant differences were observed in the incidence of postoperative complications among the three groups. With regard to postoperative complaints reported three months after surgery, GTET demonstrated superior alleviation of anterior chest discomfort and swallowing difficulties. Patients who underwent ET reported significantly higher cosmetic satisfaction levels. Additionally, the learning curve of GTET was 27 cases, and the operation time during the mature phase of the learning curve exhibited a significant reduction when compared to ETA.ConclusionsThe findings of this study affirm the safety and feasibility of employing GTET and ETA for the surgical management of PTC. GTET presents an attractive surgical option, particularly for patients with unilateral PTC who place a premium on cosmetic outcomes.

Clinical effect of Lymph Node Dissection in the Lateral Neck for the treatment of Papillary Thyroid Carcinoma: Endoscopic Thyroidectomy versus Open Surgery.

To compare the clinical effect, safety, and cosmetic effect of lymph node dissection via endoscopic thyroidectomy and open surgery in the treatment of papillary thyroid carcinoma (PTC). A retrospective analysis was performed on 86 patients with PTC admitted to Baoding No.1 Central Hospital from January 2020 to December 2021. The enrolled patients were divided into the endoscopic thyroidectomy (n = 34) and open surgery (n = 52) groups based on different surgical methods. Further comparison was conducted on the surgical indexes, postoperative complications, changes of oxidative stress indexes, numerical score system (NSS) score of postoperative cosmetic satisfaction, scar length, and recurrence rate between the two groups. The operation time was longer, and the intraoperative blood loss was lower for the endoscopic thyroidectomy group than those for the open surgery group (P < 0.05). The oxidative stress indexes of the endoscopic thyroidectomy group were significantly better than those of the open surgery group (P< 0.05). The postoperative complication rate of the endoscopic thyroidectomy group was lower than that of the open surgery group (P < 0.05). At six months after surgery, the scar length was shorter, and the NSS score was higher in the endoscopic thyroidectomy group than those in the open surgery group (P < 0.05). Endoscopic thyroidectomy for PTC is safe and effective, with mild stress response, fewer postoperative complications, and good cosmetic effect.

Clinical efficacy and inflammatory reaction of submental endoscopic thyroidectomy versus conventional thyroidectomy: A prospective randomized study

ObjectivesThis prospective study aimed to explore the clinical efficacy and inflammatory reaction of submental endoscopic thyroidectomy versus conventional thyroidectomy. MethodsWe prospectively recruited 45 patients (total 90 patients) who met the eligibility criteria to undergo conventional open thyroidectomy or submental endoscopic thyroidectomy from January 2021 to July 2022 in the Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine. These patients were evaluated using the following indices: number of lymph nodes dissected, complications, pain severity, inflammatory indicators, cosmetic satisfaction, and economic cost. All data were analyzed by the t-test or chi-squared test. ResultsNinety patients were enrolled. The two groups did not significantly differ regarding baseline characteristics. All patients who underwent thyroidectomy had a similar trauma index and increased level of inflammation. There were no significant differences between the open thyroidectomy and submental endoscopic thyroidectomy groups in the total number of lymph nodes dissected, number of positive lymph nodes, drainage volume, and complications. The Vancouver scar score and cosmetic satisfaction score were significantly better in the submental endoscopic thyroidectomy group than the open thyroidectomy group. The submental endoscopic thyroidectomy group had a significantly lower pain scores on postoperative days 1 and 2, less downtime, and cheaper medical and esthetic costs than the open thyroidectomy group. ConclusionCompared with conventional open thyroidectomy, submental endoscopic thyroidectomy did not increase the degree of trauma, had superior clinical efficacy, caused less pain, required a shorter downtime, achieved a better cosmetic effect, and was associated with lower healthcare costs.

Robotic bilateral axillo-breast versus endoscopic bilateral areola thyroidectomy outcomes of 757 patients.

Remote endoscopic thyroidectomy (ET) and robotic thyroidectomy (RT) seem to be beneficial in selected situations to avoid anterior neck scars. There are limited data in the literature to determine whether RT via a bilateral axillo-breast approach (RT-BABA) is superior to ET via a bilateral areolar approach (ET-BAA). Therefore, the aim of this study was to evaluate the surgical outcomes of RT-BABA versus ET-BAA. Between May 2013 and May 2022, 757 patients who underwent RT-BABA or ET-BAA at a high-volume Chinese thyroid center were included. Intraoperative and postoperative outcome parameters were collected and retrospectively analyzed. The moving average method was used to evaluate the learning curve. The proportion of patients older than 45 years was greater in the RT group than in the ET group (14.8% vs. 7.4%, p < 0.001). The percentage of overweight patients was greater in the RT group (28.8% vs. 9.5%, p < 0.001). The number of patients treated for malignant lesions was higher in the RT group (86.8% vs. 75%, p < 0.001). The rate of thyroiditis was higher in the RT group (10.9% vs. 6.6%, p < 0.001). Surgical time was significantly shorter in the RT group (140 vs. 165min, p < 0.001). Drainage volume was higher in the RT group (100 vs. 85ml, p < 0.001). Postoperative hospital stay was shorter in the RT group (3.04 ± 0.44 vs. 3.67 ± 0.89 days, p < 0.001). The cost in the RT group was higher (49627 ± 2795 vs. 25094 ± 3368 yuan, p < 0.001). Transient vocal cord dysfunction was lower in the RT group (2.9% vs. 8.0%, p = 0.003). There was no significant difference between the two groups in the number of central lymph nodes sampled, positive lymph nodes, neural monitoring (EMG) results, and rate of transient hypoparathyroidism. The learning curve for RT was 26 cases, and the operative time for ET was constant throughout the study. RT-BABA is as safe and feasible as ET-BAA. RT-BABA performed better in some surgical outcomes. Further prospective studies are needed to confirm the safety of RT-BABA.

Comparison of surgical smoke between two approaches for endoscopic thyroidectomy and open thyroidectomy

Surgical smoke has been recognized as a potential health risk by an increasing number of researchers. Moreover, the counts of surgical smoke produced during different surgical approaches are different. This study aimed to measure and compare the particulate matter (PM) of surgical smoke generated during open thyroidectomy and two endoscopic approaches for thyroidectomy to provide guidance for safe clinical practices. Forty-eight patients with thyroid cancer admitted to our hospital from June 2020 to December 2021 and treated with different surgical approaches were enrolled in this study. The total and peak counts of PM, dynamic changes, and other characteristics of surgical smoke produced during surgery were recorded. PM was classified as PM2.5 (size ≤ 2.5μm) and PM10 (size ≤ 10μm). In a single cut, both the peak and total counts of PM2.5 and PM10 of surgical smoke in the open thyroidectomy group (n = 15) were significantly higher than those in the breast approach endoscopic thyroidectomy with CO2 insufflation group (n = 15) and the gasless transaxillary endoscopic thyroidectomy group (n = 18) (p < 0.001). Moreover, the latter two groups showed no significant differences in the peak and total counts of PM2.5 and PM10 (p > 0.05). In thyroid surgery, more surgical smoke is produced during open thyroidectomy than during endoscopic thyroidectomy, while different endoscopic approaches showed no significant difference in surgical smoke production. Thus, endoscopic approaches outperform the open thyroidectomy approach with regard to surgical smoke production.

Comparison of Quality of Life between Patients Undergoing Submental Endoscopic Thyroidectomy and Conventional Thyroidectomy: A Prospective Controlled Clinical Trial.

The objectives of this study were to compare the surgical outcomes and quality of life between patients undergoing submental endoscopic thyroidectomy and those undergoing conventional thyroidectomy. The surgical outcomes and quality of life were recorded. Forty-eight patients were included in the study. Their ages ranged from 20 to 60 years. All patients underwent lobectomy, isthmectomy, or the combination of lobectomy and isthmectomy. Most histological diagnoses were benign (85.42%). The submental endoscopic thyroidectomy group showed better scores in the energy/fatigue, emotional wellbeing, and general health domains (p = 0.006, 0.041, and 0.004, respectively). There were no statistically significant differences in surgical outcomes between the submental endoscopic thyroidectomy and conventional thyroidectomy groups (p > 0.05). Submental endoscopic thyroidectomy is feasible, and permits a better quality of life in terms of the energy/fatigue, emotional wellbeing, and general health domains.

Endoscopic thyroidectomy versus traditional open thyroidectomy for identification of the external branch of the superior laryngeal nerve.

To explore the anatomical features of the external branch of the superior laryngeal nerve (EBSLN) and determine an effective approach for its preservation during endoscopic thyroidectomy (ET). From January 2017 to December 2018, a total of 405 consecutive patients with thyroid disease were retrospectively analyzed. These patients were divided into the ET group and the open thyroidectomy (OT) group according to the surgical approaches. There were 195 cases in the ET group including 43 males and 152 females, and 210 cases in the OT group including 65 males and 145 females. The dissection process of EBSLN, detection rate, distribution of identification methods of the EBSLN and rate of voice change were recorded. There were 205 EBSLNs detected under direct vision in ET group for a detection rate of 88.0%, while 158 EBSLNs were detected under direct vision in OT group for a detection rate of 58.1%. But with the assistant of intraoperative neuromonitoring (IONM), the number of EBSLNs detected visually reached up to 220 in ET group and 226 in OT group, respectively, for a visual detection rate of 94.4% and 83.1%, respectively. There were significant difference in the rate of direct visual identification, total visual identification with IONM. Stratified risk estimation indicated that the tumor size and location were risk factors for the direct visual dissection of EBSLN. Stratified analysis by tumor size indicated that when tumor diameter was ≤ 4cm, the incidence of vocal cord fatigue and total vocal changes in ET group was significantly lower than that in OT group. Recognition and exposure of the EBSLN can be facilitated by the magnification and focusing function of high-definition endoscopy and the advantage of a 30° variable angle. Full exposure of the sternothyroid-laryngeal triangle and fine dissection along the superior thyroid vessels is beneficial for recognizing the EBSLN.

Comparison of long-term surgical outcome between transaxillary endoscopic and conventional open thyroidectomy in patients with differentiated thyroid carcinoma: a propensity score matching study.

There is an increased use of endoscopic thyroidectomy (ET), including robotic-assisted thyroidectomy (RT), to avoid postoperative scars on the anterior neck. The objective of this study was to compare the surgical and oncologic outcomes between ET and conventional open thyroidectomy (COT) for differentiated thyroid carcinoma (DTC). We reviewed 4129 patients with DTC who underwent thyroid lobectomy at Seoul St. Mary's Hospital (Seoul, Korea) from January 2009 to December 2014. Patients were categorized according to the type of surgery and statistically compared using propensity score matching analysis. The mean operation time was significantly longer in the ET group than in the OT group (101.2 ± 26.2min vs. 86.4 ± 27.0min, p < 0.001). The number of harvested lymph nodes was significantly lower in the ET group than in the OT group (5.5 ± 4.2 vs. 8.3 ± 6.2, p < 0.001). There was no significant difference in the recurrence rate between the two groups (p = 0.879). Kaplan-Meier analysis revealed no significant difference in the disease-free survival after propensity score matching (p = 0.811). The mean follow-up duration was 90.4 ± 21.0months. Transaxillary ET including RT for DTC is a safe and feasible alternative to COT with a cosmetically desirable outcome. Further studies are required to confirm our results.

Comparative study of bilateral axillo-breast approach endoscopic and robotic thyroidectomy: propensity score matching analysis of large multi-institutional data.

PurposeThe aim of this study was to compare the large multi-institutional data of surgical outcomes of bilateral axillo-breast approach (BABA) robotic (RT) and endoscopic thyroidectomy (ET) and to evaluate the merits of robotic thyroidectomy.MethodsFrom 2004 to 2015, 1,029 patients underwent BABA ET, and from 2008 to 2015, 2003 patients underwent BABA RT in 3 large volume centers in Korea. Two groups were retrospectively compared in terms of clinicopathologic characteristics, complications, surgical completeness, and long-term outcomes using propensity score matching analysis.ResultsBoth groups had similar demographic characteristics including age, sex, tumor size, pathologic stage, and hospital stay after matching. Each group had similar rate of transient hypoparathyroidism, however, ET showed significantly higher rate of permanent hypoparathyroidism (ET 5.2% vs. RT 2.3%, P = 0.05), and transient vocal cord palsy (ET 14.4% vs. RT 9.1%, P = 0.006). Total operation time was longer in the ET group irrespective of surgical extents, including lobectomy (P = 0.016), total thyroidectomy (P = 0.031), and total thyroidectomy with central lymph node dissection (P = 0.019). The rate of patients with off-Tg under 1.0 ng/mL after 1st ablation was significantly higher in RT than ET group (ET 64.6% vs. RT 92.7%, P < 0.001). In long-term follow-up of cancer patients, 1.4% experienced recurrence after ET (10 cases), while 0.3% cases experienced recurrence after RT (5 cases) (P < 0.001).ConclusionBoth ET and RT can be safe and effective methods to treat thyroid diseases. However, the application of robotic system may help to overcome the limitations of the instruments and surgeon's skills.

Comparison of conventional thyroidectomy and endoscopic thyroidectomy via axillo-bilateral breast approach in papillary thyroid carcinoma patients.

Endoscopic thyroidectomy has been applied to solve the cosmetic problems that resulted from conventional thyroidectomy. The aim of this study was to evaluate and compare the surgical outcomes of conventional and endoscopic thyroidectomies via axillo-bilateral-breast approach (ABBA) in patients with papillary thyroid carcinoma (PTC). Between May 2007 and February 2011, 1003 patients with PTC underwent thyroidectomies. The eight hundred and thirty patients underwent conventional thyroidectomy and 173 patients underwent endoscopic thyroidectomy via ABBA. Clinicopathologic characteristics, complications, and surgical completeness were analyzed. The mean age was 49.53years who received a conventional thyroidectomy and 38.90years in endoscopic thyroidectomy (P<0.0001). The conventional thyroidectomy group underwent more extensive surgery than the endoscopic thyroidectomy group but the operation time was longer in the endoscopic thyroidectomy group (P<0.0001). The mean hospitalization length was 6.98days following open thyroidectomy and 6.40days after endoscopic thyroidectomy (P=0.003). The tumor size was larger in the conventional thyroidectomy group than the endoscopic thyroidectomy group and a lesser number of lymph nodes were retrieved in the endoscopic thyroidectomy group compared to the conventional thyroidectomy group (P<0.0001). The postoperative complications and thyroglobulin levels in both groups were not significantly different. These results suggest that conventional and endoscopic thyroidectomy via ABBA has similar surgical outcomes in PTC patients. Therefore, endoscopic thyroidectomy via ABBA may be an appropriate surgical alternative to conventional thyroidectomy for treating PTC in selected patients.

Comparative study comparing endoscopic thyroidectomy using the axillary approach and open thyroidectomy for papillary thyroid microcarcinoma

BackgroundEndoscopic thyroidectomy has been applied prudently to malignant thyroid tumors. The purpose of our study was to compare the surgical outcomes of endoscopic thyroidectomy (ET) and conventional open thyroidectomy (COT) for micropapillary thyroid carcinoma.MethodsFrom October 2002 to December 2008, 78 patients underwent unilateral lobectomy and isthmectomy with central lymph node dissection for papillary thyroid microcarcinoma. Of these, 37 patients underwent ET and 41patients COT. Surgical outcomes, including operation time, number of retrieved lymph nodes, postoperative complication rate and patients’ satisfaction with the cosmetic results, were analyzed.ResultsThe mean age of the patients was 42.3 ± 7.6 years in the ET group and 49.0 ± 10.8 years in the OT group (P = 0.003). The operation time was shorter in the COT group (112.3 ± 14min) than in the ET group (138.4 ± 36.9 min, P< 0.01). However, there were no significant differences in tumor size (0.5 ± 0.231vs. 0.41 ± 0.264cm, P = 0.116), number of retrieved lymph nodes (3.63 ± 2.1vs. 3.82 ± 3.28, P = 0.78) or postoperative hospital stay (3.35 ± 0.94vs. 3.17 ± 1.16 days, P = 0.457). Patients in the ET group experienced more pain than those in the COT group at 1 and 7 days after the operation as evaluated by a visual analog scale (P = 0.037, 0.026). Cosmetically, patients in the ET group were very satisfied with the operative procedure according to the questionnaire we used (1.43 ± 0.55vs. 3.21 ± 0.72, P< 0.001). The mean follow-up period was 54.3 months in the ET group and 47.4 months in the COT group, and each group exhibited one case of tumor recurrence detected at the other thyroid lobe within 2 years.ConclusionsLarge series of prospective studies and long-term follow-up are needed, but the results of ET using the axillary approach for micropapillary thyroid carcinoma were not inferiortothose using COT, and it might be a safe and feasible procedure with good cosmetic results.

Endoscopic Thyroidectomy for Bilateral Thyroid Diseases

The aim of this study was to assess the safety and efficacy of endoscopic thyroidectomy (ET) for bilateral thyroid diseases. From March 2001 to January 2011, we performed a retrospective review of 30 cases of ET via breast approach for bilateral thyroid diseases. We rendered 50 cases of unilateral ET (group 2) and another 30 cases of open thyroidectomy for bilateral thyroid diseases (group 3) as control groups. Comparison between groups 1 and 2 and groups 1 and 3 in perioperative details and follow-up was reviewed. The patients in group 1 required longer operating time, more intraoperative blood loss, more amount of drainage, and longer postoperative hospital stay compared with group 2. Compared with group 3, the patients in group 1 were associated with more operating time but less estimated blood loss, less amount of drainage, and shorter postoperative drainage stay. In group 1, 5 cases have temporary postoperative complications but completed resolution. No recurrence occurred, and all patients were satisfied with their excellent overall cosmesis and the surgical outcome of the procedure. Endoscopic thyroidectomy is a safe and feasible procedure for bilateral thyroid disease with a good prognosis.

Comparison study on operative trauma between endoscopic thyroidectomy and traditional thyroidectomy

Objective To explore the injury of endoscopic thyroidectomy via breast areola approach and the anterior chest wall to human body. Methods Sixty patients with thyroid benign tumor, hospitalized from Janurary 2009 to December 2010, were divided into endoscopic thyroidectomy group and traditional thyroid surgery group with respect of the patients' own willing. The levels of interleukin (IL)-2,IL-6, C-reactive protein ( CRP), tumor necrosis factor (TNF)-o in the blood were determined 2 h, 1 day and 3 days after surgery. Results No statistically significant difference was found between the 2 groups in the levels of IL-2[endoscopic group: ( 12. 6 ± 2. 1 ), ( 11.8 ± 1.9), ( 11.8 ± 3.0) ng/L; traditional group: (10.6±1.1), (11.2±2.6), (12.0 ±3.2) ng/L], CRP[endoscopic group: (1.6±0.7),(2.4±0.9), (2.5±0.9) mg,/L; traditional group: (0.8±0.6), (2.4±0.5), (2.4±0.7) mg/L],TNF-αt[endoscopic group: (53.2 ±6. 8), (49. 1 ±5.5), (46. 5 ±5.0) ng/L; traditional group: (48. 5±7. 1 ), (51.3 ±6. 2), (41.5 ± 13.7) ng/L]at different time points. The levels of IL-6 showed significant difference between two groups at 2nd h and first day after surgery ( P ＜ 0. 05 )[endoscopic group:(4.8 ±2.4), (4.3 ±2. 1), (5.4 ±5.6) ng/L; traditional group: (6.4±2.4), (7. 1 ±4. 1), (4.9 ±0. 8) ng/L]. Conclusion Compared with traditional surgery, endoscopic thyroidectomy is relatively minimally invasive and worthy of being widely applied for its preservation of the outlook of patients and not increasing the injury to patients. Key words: Thyroid benign tumor; Endoscopic thyroidectomy

Endoscopic vs. conventional thyroidectomy for the treatment of benign thyroid tumors: A retrospective study of a 4-year experience

Endoscopic thyroidectomy (ET) allows surgeons to remove a thyroid tumor from a remote site, while providing excellent results from a cosmetic viewpoint. The aim of this study was to explore the appropriateness and outcomes of ET via breast approach for the treatment of benign thyroid tumors. A total of 637 patients with benign thyroid tumors were recruited in our department. Two hundred and eighty-five patients underwent the ET via breast approach (ET group) and 352 matched control patients underwent conventional thyroidectomy (ConT group). Variables, such as surgery-related outcomes and postoperative complications, were compared between these two groups. A unilateral lobectomy was performed in 126 patients (44.2%) of the ET group and in 163 patients (46.3%) of the ConT group. A bilateral total thyroidectomy was performed in 159 patients (55.8%) of the ET group and in 189 patients (53.7%) of the ConT group. The operative time in the ET group was longer compared to the ConT group (79.9±20.10 vs. 45.4±11.90 min, P<0.001, for unilateral lobectomy; and 89.9±14.60 vs. 60.0±8.44 min, P<0.001, for bilateral total thyroidectomy). The ET group had a significantly longer mean hospital stay compared to the ConT group (5.5±0.50 vs. 5.3±0.75 days, P=0.002). There was no case of conversion to conventional open surgery in the ET group. The recurrent laryngeal nerves and parathyroid glands were identified and protected in all cases. Our results indicate that ET performed via breast is a technically feasible and safe procedure with excellent cosmetic results for patients with benign thyroid tumors.

Comparison of the surgical stress between endoscopic thyroidectomy via anterior chest approach and conventional thyroidectomy

To evaluate the difference in surgical stress between gasless endoscopic thyroidectomy through anterior chest approach and conventional thyroidectomy. The patients with thyroid nodules who would undergo thyroidectomy between November 2006 and February 2008 in Department of Otorhinolaryngology Head and Neck Surgery, Second Affiliated Hospital of Sun Yat-sen University, were randomly divided into gasless endoscopic thyroidectomy group or conventional thyroidectomy group, with 25 cases and 22 cases respectively. Before and after surgery, white blood cell count (WBC), serum C-reactive protein (CRP) and interleukin-6 (IL-6) were measured to assess the surgical stress response. At 12 h, 24 h and 48 h after surgery, no significant difference was found between the two groups in WBC (t = -0.172, 1.774 and 2.039 respectively, P > 0.05), serum CRP (t = -0.927, -1.701 and -1.813, P > 0.05) and IL-6 (t = 0.098, -2.019 and -1.121, P > 0.05). The stress response of gasless endoscopic thyroidectomy is similar with that of conventional thyroidectomy.

Effect of Endoscopic Thyroidectomy via Anterior Chest Wall Approach on Treatment of Benign Thyroid Tumors

The aim of this study was to evaluate the inflammatory response and acid-base equilibrium index, as well as other clinical facts of the endoscopic thyroidectomy via the anterior chest wall approach. Thirty-nine patients who received thyroidectomy in our surgical center during September 2007 and January 2008 were included in this study. Twenty of the patients underwent an endoscopic surgery, and the remaining 19 received conventional surgery. These patients' data were compared within and between treatment groups with respect to clinical facts and inflammatory evaluations. Arterial blood gas data and electrolyte data were analyzed within the endoscopic group. Endoscopic thyroidectomy group showed shorter operative time, compared to that of the conventional thyroidectomy group, although the difference didn't reach statistical significance. No significant difference regarding postoperative hospital stay was observed between two groups. Postoperative day 1 shows much higher values of interleukin-6 and tumor necrosis factor than that measured preoperative or postoperative day 3 in both groups. C-reactive protein appeared to be significantly increased postoperatively in both groups, although no difference between the two groups was found. Although blood cortisol significantly increased in both groups postoperatively, the data of endoscopic group postoperative day 1 was lower than the same day of the conventional group. Arterial blood gas analysis showed that both PCO2 and TCO2 were statistically different between preoperation and 30 minutes after insufflation. No insufflation complication was observed. Compared with conventional thyroid surgery, endoscopic thyroidectomy via the anterior chest wall approach presented with no significant difference in respect of both clinical facts and laboratory outcomes.

Effect of Endoscopic Thyroidectomy via Anterior Chest Wall Approach on Treatment of Benign Thyroid Tumors

Objective: To evaluate the inflammatory response and acid-baseequilibrium index, as well as other clinical facts of the endoscopicthyroidectomy via the anterior chest wall approach.Methods: 39 patients who received thyroidectomy in our surgicalcenter during September 2007 and January 2008 were included in thisstudy. Twenty of the patients underwent an endoscopic surgery, andthe rest 19 received a conventional surgery. These patients� data werecompared within and between treatment groups with respect to clinicalfacts and inflammatory evaluations. Arterial blood gas data andelectrolyte data were analyzed within the endoscopic group.Results: Endoscopic thyroidectomy group showed shorter operativetime compared to that of conventional thyroidectomy group, althoughthe difference didn�t reach statistical significance. No significantdifference regarding postoperative hospital stay was observed betweentwo groups. Postoperative day 1 shows much higher values of IL-6and TNF than that measured preoperative or postoperative day 3 inboth groups. CRP appeared to be significantly increasedpostoperatively in both groups, although no difference between thetwo groups was found. Although blood cortisol significantly increasedin both groups postoperatively, the data of endoscopic grouppostoperative day 1 was lower than the same day of conventionalgroup. Arterial blood gas analysis showed that both PCO2 and TCO2were statistically different between preoperation and 30 min afterinsufflation. No insufflation complication was observed.Conclusion: Compared with conventional thyroid surgery, endoscopicthyroidectomy via anterior chest wall approach presented with nosignificant difference in respect of both clinical facts and laboratoryoutcomes.

Comparison of Changes in Arterial Blood Gases during Endoscopic Thyroidectomy, Laparoscopic Cholecystectomy and Gynecologic Laparoscopic Surgery

Background: Because laparoscopic surgery has many advantages compared with conventional methods, it has recently been applied to not only intraabdominal or intrathoracic surgery but also thyroidectomy. It is possible that arterial blood gases and hemodynamic variables can be changed by patient position and insufflation of pressurized CO2 into extraperitoneal or intraperitoneal space, so we examined the changes in arterial blood gases, end tidal CO2 (PETCO2) and hemodynamic variables during an endoscopic thyroidectomy with extraperitoneal CO2 insufflation, laparoscopic cholecystectomy and gynecologic laparoscopic surgery with intraperitoneal CO2 insufflation under N2O, enflurane inhalational general anesthesia. Methods: Forty ASA class I or II patients were included in this study, endoscopic thyroidectomy group (n = 10), laparoscopic cholecystectomy group (n = 18), gynecologic laparoscopic surgery group (n = 12). All patients were underwent controlled mechanical ventilation (tidal volume: 10 ml/kg, respiratory rate: 12/min) and the ventilator mode was fixed in this volume and rate until the end of the operation. The position of patients during the endoscopic thyroidectomy and laparoscopic cholecystectomy were under 5 degree reverse Trendelenburg position, whereas the gynecologic laparoscopic surgery was under a 10 degree head-down lithotomy position. Variables were measured before CO2 insufflation (10 minute after induction), 10, 20 and 30 minutes after CO2 insufflation and 40 minutes after CO2 deflation. Results: PaCO2 and PETCO2 were significantly increased during CO2 insufflation compared with preinsufflation values in all groups, but the magnitude of increases of PaCO2 and PETCO2 was not significantly different among the three groups. The mean magnitude of increases of PaCO2 at 10 minutes after CO2 insufflation were as follows: gynecologic laparoscopic surgery (6.21 2.0 mmHg), endoscopic thyroidectomy (5.07 2.3 mmHg), and laparoscopic cholecystectomy (5.01 G 2.2 mmHg).