Safety Of Endoscopic Thyroidectomy Research Articles

The impact of coexisting Hashimoto's thyroiditis on the feasibility of endoscopic thyroidectomy in papillary thyroid carcinoma

Objective：The safety of endoscopic thyroidectomy in patients with Hashimoto's thyroiditis (HT) is a matter of concern. This study aimed to assess the effect of concomitant HT on the feasibility of endoscopic thyroidectomy in patients with papillary thyroid carcinoma (PTC). MethodsThis study is an observational, retrospective study. All patients were histopathologically diagnosed with HT. The study group consisted of 44 patients (40 %) with PTC who also had HT, whereas the remaining 66 patients (60%) without HT were assigned to the control group. The number of dissected lymph nodes, mean operation time, thyroid volume, blood loss, TSH level, and postoperative complications were recorded and statistically analysed. ResultsOne patient underwent conversion to open thyroidectomy because of recurrent laryngeal nerve (RLN) transection. Another patient required reoperation owing to postoperative haemorrhage. Statistically significant differences were observed in mean operation time (105.4 ± 10.7 vs 98.2 ± 7.4 min, P = 0.0001),mean thyroid lobe volume (12.2 ± 5.8 vs 9.6 ± 3.5 mL [mL], P = 0.0041), TSH level(4.1 ± 1.5 mIU/L vs 3.4 ± 0.9 mIU/L, P ＝ 0.0028), and the number of dissected lymph nodes between groups (4.1 ± 1.5 vs 3.4 ± 0.9,P = 0.0028). The estimated mean blood loss (31.5 ± 6.8 vs 29.5 ± 3.9 mL, P = 0.0529) and rate of complications (15.9% vs 10.6%, P = 0.4136) did not show statistically significant differences between groups. ConclusionThe coexistence of PTC and HT increases the operation time and difficulties in endoscopic thyroidectomy but does not affect postoperative outcomes. Endoscopic thyroidectomy can be safely performed with acceptable complication rates.

Feasibility and Safety of Endoscopic Thyroidectomy Via a Unilateral Axillobreast Approach for Unilateral Benign Thyroid Tumor in Vietnam.

The purpose of this research study was to assess the safety and surgical outcomes of endoscopic thyroidectomy applied via a unilateral axillobreast approach with CO2 insufflation to one-sided benign thyroid tumors in Vietnam. Only 1 patient of the 50 (2%) had a postoperative hematoma at the surgery site. Open surgical conversions did not occur. The duration of postoperative drainage was from 3 to 8 days, or 4.86±1.24 days on average. The length of stay in the hospital after surgery was 4 to 9 days, or 5.9±1.2 days on average. The postoperative pain in the first postoperative days was lower in intensity compared with open surgeries. The given method provided better results in terms of patient satisfaction with the cosmetic effect of the surgery compared with up-front surgery, minimally invasive video-assisted thyroidectomy, and endoscopic procedures via the breast approach, and 96% of patients were completely satisfied.

Endoscopic Thyroid Surgeries via Areola Approach: Experience and Outcomes of 500 Cases in a Single Institute

With the growing popularity of endoscopic thyroid surgery for treatment of thyroid diseases, this study aimed to summarize our experience of endoscopic thyroidectomy (ETE), and evaluate the feasibility and safety of ETE, in our institute. Five hundred patients underwent ETE via the areola approach. The learning curve, clinicopathologic characteristics, cosmetic satisfaction, complications, and so on were analyzed. Among the 500 cases, 497 were successfully managed with ETE, and 3 were converted to open procedure. The score of cosmetic satisfaction, average operation time, tumor diameter, mean total intra-operative blood loss, hospital stay, drainage time, and age were 9.4 ± 0.5, 142 ± 20 min, 2.6 ± 1.2 cm, 34 ± 12 ml, 11.4 ± 3.6 days, 3.3 ± 0.7 days, and 44.2 ± 11.9 years, respectively. Pathological types of the tumor included papillary thyroid carcinoma (PTC; n = 87), nodular goiters (n = 283), follicular adenoma (n = 84), and others (n = 46). The complications included transient recurrent laryngeal nerve (RLN) palsy (n = 15, 3.0%), transient superior laryngeal nerve (SLN) palsy (n = 3, 0.6%), transient hypoparathyroidism (n = 32, 6.4%), tracheal injury (n = 1, 0.2%), swallowing discomfort (n = 20, 4.0%), infection (n = 7, 1.4%), and others (n = 15, 3.0%). No patients experienced permanent RLN injury or SLN injury, asphyxia/dyspnea, esophagus injury, bleeding, chylous fistula, or death. Among the cases of PTC, 76 (87.4%) cases underwent the central lymph node dissection. The mean number of retrieved lymph nodes was 6.4 ± 2.1, while the mean number of metastatic central lymph nodes was 1.2 ± 2.3. The ratios of capsule invasion, central lymph node metastasis, and extrathyroidal extension were 10.3, 26.4, and 3.4%. ETE via areola approach is safe, feasible, and cosmetic, with good operative results and low complication rates. It provides an effective choice for treating patients.

Minimally invasive endoscopic thyroidectomy via an anterior chest approach for early papillary thyroid cancer

To evaluate the feasibility and safety of endoscopic thyroidectomy via anterior chest approach for early papillary thyroid cancer (T1N0M0). From July 2004 to December 2010, 91 patients with early papillary thyroid cancer underwent minimally invasive endoscopic thyroidectomy via anterior chest approach. The clinical and pathologic characteristics of patients, operation types, operative time, postoperative hospital stay time, and postoperative complications were analyzed retrospectively. All 91 operations were successfully performed endoscopically. There was no case conversed to open surgery. The mean tumor size was (0.96 ± 0.71) cm. The operation types included unilateral lobectomy (41 cases), unilateral subtotal lobectomy (3 cases), ipsilateral lobectomy and contralateral subtotal lobectomy (42 cases), and bilateral total thyroidectomy (5 cases). Central compartment node dissection was carried out in 39 cases with the tumor diameter less than 1.0 cm and in 29 cases with the tumor diameter of 1.0 - 2.0 cm. The mean operating time was (99 ± 17) min, the mean bleeding volume was (18 ± 12) ml, and the mean post-operative hospital stay time was (3 ± 1) days. Temporary recurrent laryngeal nerve (RLN), paresis occurred in 2 cases and recovered within 1 to 2 months after the surgery. One patient showed permanent RLN paralysis. Two patients showed temporary hypoparathyroidism. No patient showed post-operative seroma and tracheal injury. There was no case with injury to the superior laryngeal nerve. No further complications, such as irritating cough, tetany, and emphysema developed after the operation. With the anterior chest wall approach, all patients had no surgical scar on the neck and thus they were satisfied with the cosmetic outcomes. All patients were disease free by follow-up of 7 to 85 (58.4 ± 17.2) months. Minimally invasive endoscopic thyroid surgery through anterior chest approach is a feasible and safe method for the treatment of early papillary thyroid cancer. This technique had better cosmetic results and the long-term effect of this technique needs further evaluation.

Increasing the Size Limit of Benign Thyroid Lesions Resectable by Endoscopic Thyroidectomy via a Unilateral Axillo‐breast Approach Without Gas Insufflation

Endoscopic thyroidectomy is rarely attempted in patients with large goitrous lesions. We examined the feasibility and safety of endoscopic thyroidectomy via a unilateral axillo-breast approach without gas insufflation for resection of large thyroid tumors (≥4 cm). The study included 111 patients: 82 in group 1 (tumor diameter <4 cm) and 29 in group 2 (≥ 4 cm). Ninety-one patients underwent hemithyroidectomy and 20 underwent total thyroidectomy. Local complications, surgical outcomes, and pathological outcomes were compared between groups. Postoperative permanent pathology revealed 24 follicular adenomas and 87 nodular hyperplasias. The mean tumor size in group 2 was 51.10 ± 7.66 mm compared to 25.24 ± 8.14 mm in group 1. The mean volume of the thyroid gland in group 2 was 15.60 ± 3.45 cm(3) compared to 11.27 ± 2.40 cm(3) in group 1 (p = 0.000). Mean operating time did not differ significantly between groups (p = 0.520). Postoperatively, minor hematomas were encountered in three patients (3.7%) in group 1. Three patients in group 1 (3.7%) and two in group 2 (6.9%) developed transient unilateral vocal cord palsy (p = 0.604). Temporary hypocalcemia was observed in six and one patients in groups 1 and 2, respectively (p = 1.000). No permanent recurrent laryngeal nerve palsy or hypoparathyroidism occurred in either group. Our data support the safety and feasibility of endoscopic thyroidectomy via a unilateral axillo-breast approach without gas insufflation, even for the treatment of benign thyroid lesions ≥4 cm.

Endoscopic thyroidectomy: an evidence-based research on feasibility, safety and clinical effectiveness

The feasibility and safety of endoscopic thyroidectomy were evaluated by an approach of systematic review of published studies in the past decade. A database searching was performed on MEDLINE, Cochrane Database of Systematic Reviews, American College of Physicians Journal Club, Database of Abstracts of Reviews of Effects, Cochrane Central Register of Controlled Trials. Both comparative and non-comparative studies about endoscopic thyroidectomy were selected and analyzed. For the comparative studies, RevMan 4.2 was used for statistical analysis; and for the non-comparative studies, data analysis was performed by SPSS 13.0. Seven comparative studies involving 367 patients (video-assisted thyroidectomy (VAT), 174 patients; conventional thyroidectomy (CT), 193 patients) were included in VAT-CT group. Age, gender, operative types, and pathological diagnosis were similar. Compared with CT, the mean operative time for VAT was significantly longer (VAT, 80.0 minutes; CT, 61.9 minutes, P < 0.01), but the postoperative hospital stay was shorter (VAT, 1.7 days; CT, 2.5 days, P < 0.01). The complication rate for VAT was 6.9%, while that for CT was 9.3% (P = 0.35). Three studies analyzed the postoperative pain and cosmetic evaluation, and indicated that the VAT group was superior to the CT group, but there was no significant difference after a meta-analysis. Three comparative studies involving 273 patients (totally endoscopic thyroidectomy (TET), 145 patients; CT, 128 patients) were included in TET-CT group and the results generally resembled that of VAT-CT group. There were 18 and 14 non-comparative studies reporting the results of VAT and TET, respectively. The mean operative time for VAT was 76.8 minutes compared with 135.8 minutes for TET. The postoperative hospital stay was 1.8 and 3.8 days for VAT and TET respectively. The rates of conversion to open surgery for VAT and TET were similar (VAT, 2.8%; TET, 3.9%, P = 0.105). The complication rate for VAT was 8.6%, while that for TET was 3.5% (P < 0.01). The feasibility and safety of endoscopic thyroidectomy were initially verified and accepted, and it should be considered as a valid option, offering some advantages to patients in terms of cosmetic results and postoperative distress.

Endoscopic thyroidectomy through anterior chest and breast approach for papillary thyroid microcarcinoma

To evaluate the operative feasibility and safety of endoscopic thyroidectomy through anterior chest and breast approach for the treatment of the patients with papillary thyroid microcarcinoma (PTMC). Endoscopic thyroidectomy was attempted in 164 patients with thyroid diseases. For 28 cases, which were diagnosed as PTMC by frozen section intraoperatively, lobotomy plus central compartment dissection and contralateral subtotal lobotomy was achieved completely by endoscopic thyroidectomy. There were 27 females and 1 male, and their average age was 35.2 years old. Twelve and sixteen cases were diagnosed preoperatively as thyroid microcarcinomas and benign tumors, respectively. The operation time of the 28 cases was (115 +/- 43) min. The maximum diameter of PTMC was 0.2 to 1.0 cm with a mean of 0.56 cm. 17.9% (5/28) of the PTMC patients had transient vocal cord palsy and restored after 1 to 2 months postoperatively. There were no complications such as subcutaneous emphysema and postoperative bleeding and postoperative hypocalcaemia. 46.4% (13/28) had node involvement of the central compartment. Postoperative ultrasonography and scintigraphy showed no evidence of recurrence or residual thyroid tissue in the thyroid bed where lobotomy was performed. The endoscopic thyroidectomy through anterior chest and breast approach is a choice of the surgical treatment for selected cases of PTMC.

Gasless Endoscopic Thyroidectomy via an Anterior Chest Wall Approach Using a Flap-Lifting System

PurposeEndoscopic thyroidectomy (ET) requires a proper working space for adequate visualization of anatomical structures and proper instrument manipulation. The purpose of this prospective study was to estimate the feasibility and safety of ET using an anterior chest wall approach without gas insufflation.Materials and MethodsThe working space was created under a direct and endoscopic view through a 3-cm incision on the anterior chest wall. A retracting device was then inserted to establish the working space, and subsequent procedures were performed endoscopically. All data were reviewed using a prospective database.ResultsWe performed 30 ETs in patients with benign thyroid tumors from December 2003 to December 2005. The procedures were completed successfully in 29 patients (mean operative time: 160.6 min; range: 90-345 min). One patient with ET was converted to open thyroidectomy secondary to substernal extension of the tumor. None of the patients developed permanent postoperative hypocalcemia or recurrent laryngeal nerve paralysis. Three patients exhibited some degree of transient recurrent laryngeal nerve palsy.ConclusionThese data suggest that gasless ET using an anterior chest wall approach is safe and feasible in selected patients for treating benign thyroid tumors. This technique may offer good operative working space when performed by surgeons with relatively low-volume ET practices.

Thyroïdectomie endoscopique pour nodules thyroïdiens isolés

Introduction. – The aim of this study was to assess the feasibility and safety of endoscopic thyroidectomy. Materials and methods. – Between September 1998 and February 2000, 18 patients with a solitary thyroid nodule underwent endoscopic thyroidectomy in a single institution. Analgesic requirement, return to normal activity, and cosmetic results were compared to 18 consecutive patients who had conventional thyroidectomy. Results. – Sixteen females and two males, with a mean age of 43 years (17–66 years) were operated on. Indications for surgery included indeterminate cytology ( n = 8), follicular neoplasm ( n = 8), Hürthle cell neoplasm ( n = 1), and toxic thyroid nodule ( n = 1). The mean nodule diameter was 2.7 cm (0.6–7 cm). Sixteen of 18 cases were successfully completed endoscopically with a mean operating time of 220 min (120–330 min). There were no major complication, but three patients developed mild hypercarbia and one patient had an incidental parathyroidectomy. When compared to conventional thyroidectomy, patients undergoing endoscopic thyroidectomy had a significantly superior cosmetic result ( P < 0.005) and a quicker return to normal activity ( P < 0.05), but there was no difference in analgesic requirement. Conclusion. – The results of this study seem to confirm that endoscopic thyroidectomy is a technically feasible and safe procedure that leads to an improved cosmetic result and a quicker recovery. However, conventional thyroidectomy is still recommended when thyroid carcinoma is suspected.