Unilateral Axillo-breast Approach Research Articles

Surgical outcomes of endoscopic thyroidectomy approaches for thyroid cancer: a systematic review and network meta-analysis.

This network meta-analysis assesses the outcomes of seven endoscopic approaches, offering valuable insights for researchers and practitioners in choosing the best method for thyroid cancer patients. A systematic literature search was conducted in the PubMed, Embase and Web of Science databases up to March 2023. The analysis included seven endoscopic approaches, with a focus on their respective outcomes through network meta-analysis. This meta-analysis included 44 studies involving 8,672 patients. The axillo-bilateral breast approach (ABBA) and unilateral axillo-breast approach (UABA) showed advantages in terms of reduced operative time compared to other approaches (MD = 19.66 minutes, 95% CI = -31.66 to 70.98; MD = 30.32 minutes, 95% CI = -1.45 to 62.09, respectively). The UABA and anterior chest approach (ACA) exhibited superiority in controlling intraoperative bleeding (MD = -3.37 mL, 95% CI = -22.58 to 15.85; MD = -13.77 mL, 95% CI = -28.85 1.31, respectively). UABA and ACA also showed advantages in reducing hospital stays (MD = -0.39 days, 95% CI = -1.48 to 0.71; MD = -0.26 days, 95% CI = -1.33 to 0.81, respectively). The transoral approach (OA) yielded results comparable to those of conventional open thyroidectomy (COT) and outperformed other endoscopic surgeries with regards to lymph node retrieval and metastatic lymph node assessment. For the stimulated serum thyroglobulin (TG) levels, no significant difference was observed between bilateral axillo-breast approach (BABA) and OA compared to COT. However, chest-breast approach (CBA) showed significantly lower levels than COT (MD=-0.40 ng/ml, 95% CI =-0.72 to -0.09). Patients in the gasless unilateral transaxillary approach (GUA) group experienced a significant improvement in cosmetic satisfaction (MD=-2.08, 95% CI =-3.35 to -0.82). Importantly, no significant difference was observed in the incidence of surgical complications between endoscopic thyroidectomy andCOT. Endoscopic thyroid surgery is a safe and effective choice for thyroid cancer patients. Different approaches have their advantages, allowing personalized selection based on the patient's needs. ABBA and UABA have shorter operative times, while UABA and ACA excel at controlling bleeding and shortening hospital stays. OA shows promise for lymph node assessment. These findings contribute to the growing evidence supporting endoscopic methods, expanding treatment options for thyroid cancer patients.

Endoscopic thyroidectomy using the axillo-breast approach in patients with lactating and/or large ptotic breasts

IntroductionThe purpose of this study is to evaluate the outcomes of endoscopic hemithyroidectomy (EH) performed via the modified unilateral axillo-breast approach (UABA) in patients with lactating and/or large ptotic breasts. MethodsBetween 2019 and 2021, we studied the records of twenty-three eligible female patients with lactating and/or large ptotic breasts who were presented with benign unilateral thyroid nodule (s) and who were treated by EH using modified UABA at Mansoura University Oncology Center or Meet Ghamr oncology center. The demographic data, clinicopathological parameters, operative and the esthetic outcomes were collected and analyzed. ResultsNine patients (39%) were lactating. All patients were obese (the mean BMI was 37.82 ± 4.37). All patients were having large breasts, cup C and D sizes (34% of patients & 56% of patients respectively), except for only two lactating female patients who had Cup B breasts. All patients were having ptotic breasts. The thyroid nodules greatest dimension ranged from 2.1–6 cm. All procedures were completed successfully endoscopically without any perioperative adverse events except for one case with temporary hoarseness of voice and three cases with axillary port sites cellulitis. The mean operative time was 83.26 ± 7.92 min. The patient satisfaction scores were high. ConclusionEH via modified UABA in patients with lactating and/or large ptotic breasts is safe, feasible and effective procedure without adverse events. It should be offered to this group of patients as an alternative to conventional open thyroidectomy if there is no other contraindication.

Endoscopic Thyroidectomy: A 6-Year Experience from a Tertiary Care Teaching Hospital in Western India.

Background: Minimally invasive and endoscopic surgical techniques have surpassed the conventional open thyroidectomy for the treatment of thyroid nodules. Trans-axillary, Unilateral Axillo-Breast Approach (UABA), Bilateral Axillo-Breast Approach, and Trans-Oral Endoscopic Thyroidectomy Vestibular Approach (TOETVA) are the most common endoscopic procedures performed currently. This article highlights our experiences with UABA and TOETVA over a period of 6 years. Materials and Methods: Between January 2015 and December 2020, we retrospectively analyzed our experience in Endoscopic thyroidectomy with 119 patients using UABA (n = 72) and TOETVA (n = 47) in our tertiary care teaching hospital. Both approaches used the standard three-port technique. Real time angiography was performed intraoperatively using Indocyanine Green dye to delineate the vessels in all patients. Results: The mean operative time for UABA and TOETVA was 90 and 110 minutes, respectively. Estimated blood loss was 18 mL in the former and 20 mL in the latter. Temporary Recurrent Laryngeal Nerve palsy and Hypoparathyroidism were minimal with TOETVA (5 patients versus 4 patients and 7 patients versus 2 patients). Shorter duration of hospital stay was observed with UABA (3 days versus 5 days). Cosmetic satisfaction was better with TOETVA. Conclusion: Based on our 6-year experience, we propose "JJ Hospital Criteria," which we currently follow to decide which surgical approach will yield best results. UABA and TOETVA are safe, feasible, and give exceptional cosmetic satisfaction. Both approaches should be seen as complementary rather than competitive.

Unilateral axilo-breast approach (UABA) with gas insufflation versus open conventional hemithyroidectomy: A prospective comparative study

BackgroundThe objective of this study was to compare with the conventional open approach, the surgical and aesthetic results of endoscopic thyroidectomy via unilateral axillo-breast approach (UABA) with gas insufflation in patients with a unilateral thyroid nodule. MethodsBetween August 2017 and August 2020, a prospective comparative cohort study was carried out in patients proposed for hemithyroidectomy. The patients were assigned to one type of approach (Open or Endoscopic) in a successive manner. Surgical results and aesthetic satisfaction at hospital discharge and during the 12-month follow-up were evaluated and compared between both groups. ResultsA total of 200 patients were included in the study: 100 for the Open approach and 100 for the Endoscopic. The baseline patient characteristics were similar between both groups. Total operative time was longer in the Endoscopic approach, due to the time required for subcutaneous dissection (the hemithyroidectomy time was similar in both groups). There was no significant difference in the frequency of major complications. The length of hospital stay was longer (for 1 day) in the Endoscopic group. The aesthetic satisfaction of the patients was significantly higher in the Endoscopic than in the Open group (p < 0.001), at hospital discharge and at 12-month follow-up. ConclusionUABA with gas insufflation for hemithyroidectomy represents a safe and effective therapeutic option for the treatment of unilateral benign thyroid pathologies.

Thyroidectomy via unilateral axillo-breast approach (UABA) with gas insufflation: prospective multicentre European study.

BackgroundExtracervical approaches for thyroidectomy are seldom explored in the western population. The objective of this study was to evaluate the outcomes of hemithyroidectomy via endoscopic unilateral axillo-breast approach (UABA) with gas insufflation.MethodConsecutive patients undergoing UABA hemithyroidectomy for symptomatic benign or cytologically indeterminate nodules (Bethesda III lesions) of less than 5 cm from July 2015 to December 2020 at three European institutions were included. Patients were excluded if presenting with a BMI more than 25 kg/m2, had previous neck surgery and/or radiation, had bilateral thyroid lesions, retrosternal goitre, Hashimoto thyroiditis or Graves’ disease. Follow-up was carried out at 2 weeks, 3 months and 1 year. Outcomes of interest were surgical (including operating time, mean duration of hospital stay and complications) and self-assessed cosmetic outcomes.ResultsOut of 984 patients treated with hemithyroidectomy during the study interval, 253 were selected, including 214 women and 39 men. Patients’ mean age was of 46.6 years with a mean BMI of 22.57. Mean operating time was 72.9 minutes. A transient recurrent laryngeal nerve injury was reported in 3.6 per cent of the patients, but none was persistent. Transient pectoral/cervical hypoesthesia was noted in 24.1 per cent of patients, with no permanent hypoesthesia. Skin burns and subcutaneous hematoma developed in 2.4 per cent and 2 per cent of patients but resolved within the third month after surgery. There was no tracheal/oesophageal perforation, conversion to open surgery or reoperation. The final pathology revealed 241 benign nodules, nine underlying papillary thyroid carcinomas, and three cases of follicular carcinoma. Hospital discharge was achieved on the first in 68.8 per cent of the patients and on the second postoperative day in 31.2 per cent of the cases. All patients were satisfied with the cosmetic aspect.ConclusionIn selected patients, UABA with gas insufflation for hemithyroidectomy could be performed for the treatment of unilateral thyroid pathologies.

Hemitiroidectomía vía abordaje axilo-mamario unilateral (UABA) con insuflación de gas vs. convencional abierta: estudio prospectivo comparativo

BackgroundThe objective of this study was to compare with the conventional open approach, the surgical and aesthetic results of endoscopic thyroidectomy via unilateral axillo-breast approach (UABA) with gas insufflation in patients with a unilateral thyroid nodule. MethodsBetween August 2017 and August 2020, a prospective comparative cohort study was carried out in patients proposed for hemithyroidectomy. The patients were assigned to one type of approach (Open or Endoscopic) in a successive manner. Surgical results and aesthetic satisfaction at hospital discharge and during the 12-month follow-up were evaluated and compared between both groups. ResultsA total of 200 patients were included in the study: 100 for the Open approach and 100 for the Endoscopic. The baseline patient characteristics were similar between both groups. Total operative time was longer in the Endoscopic approach, due to the time required for subcutaneous dissection (the hemithyroidectomy time was similar in both groups). There was no significant difference in the frequency of major complications. The length of hospital stay was longer (for 1 day) in the Endoscopic group. The aesthetic satisfaction of the patients was significantly higher in the Endoscopic than in the Open group (p<0.001), at hospital discharge and at 12-month follow-up. ConclusionUABA with gas insufflation for hemithyroidectomy represents a safe and effective therapeutic option for the treatment of unilateral benign thyroid pathologies.

Endoscopic parathyroidectomy via unilateral axillobreast approach.

Endoscopic parathyroid and thyroid surgery is becoming increasingly common. In this study, we present the results of patients who underwent Endo- scopic parathyroid via unilateral axillo-breast approach (EP via UABA). Three patients underwent EP via UABA. Patients were discharged on the next day after surgery, while at one month follow up all of them reported no further symptoms. Operation performed via two axiller and one areolar trochar. As different from open surgery, the strap muscles don't pulled laterally and not entered into the thyroid lobe from the midline. In this technique, the strap muscles are separated from the middle part of the strap muscles and the thyroid gland is reached from the middle of the strap muscles. In this way, N. laryngeal recurrence and parathyroid gland that usually located in the posterior aspect of the thyroid gland can be revealed clearly by reducing the risk of complications. EP via UABA can be performed safe effective procedure via good cosmetic results.

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.

Evaluation of Surgical Completeness in Endoscopic Total Thyroidectomy with Central Neck Dissection via a Unilateral Axillo-Breast Approach Compared with Bilateral Axillo-Breast and Open Approach

Background and Objectives The aim of this study was to evaluate surgical completeness in endoscopic total thyroidectomy with central neck dissection via unilateral axillo-breast approach (UABA) compared with bilateral axillo-breast (BABA) and open approach (OA) by means of the radioactive iodine uptake (RAIU) ratio and thyroglobulin (Tg) of remnant thyroid. Subjects and Method From July 2010 to March 2013, 82 patients who had underwent total thyroidectomy with central neck dissection and postoperative radioactive iodine (RAI) ablation for papillary thyroid carcinoma were enrolled. Of these patients, 27 patients underwent UABA, 24 patients BABA, and 31 patients OA. Clinicopathologic data, surgical outcome, stimulated Tg and RAIU ratio on the first postoperative RAI ablation scan were compared among 3 groups. Results Patients in the endoscopic surgery groups (UABA, BABA) were younger than those in the OA groups. Invasiveness such as operation time, postoperative pain, and drain amount in UABA was less than that in BABA and severer than that in OA. Other variables regarding clinicopathologic and surgical data were not significantly different. Stimulated Tg and RAIU ratio did not show significant differences among 3 groups (p=0.659 and p=0.664). Conclusion The completeness of UABA was comparable with that of BABA and OA. The UABA may be a safe option for patients who need endoscopic thyroidectomy for papillary thyroid carcinoma. Key words: Bilateral axillo-breast approach ㆍ Completeness ㆍ Endoscopy ㆍ Thyroidectomy ㆍ Unilateral axillo-breast approach

Comparative Study of Unilateral Axillo-Breast Approach with Gas Insufflation Versus Gasless Transaxillary Approach for Endoscopic Thyroidectomy in a Single Institute

Background and Objectives There have been various approaches introduced for endoscopic thyroidectomy. This study evaluates and compares the surgical outcomes of two such approaches: the unilateral axillo-breast approach (UABA) with gas and the gasless transaxillary approach (TA). Subjects and Method We retrospectively analyzed 279 patients who underwent endoscopic thyroidectomy via UABA with gas or gasless TA from March 2008 to August 2012. Studied variables were clinicopathologic data, surgical outcomes, complications, and cosmetic satisfactions. Results Of the 279 patients, 195 (69.9%) underwent UABA with gas and 84 (30.1%) underwent gasless TA. All of the variables related to clinicopathologic characteristics showed no significant differences between the two groups. The mean operation time was significantly shorter in the UABA with gas group (131.76±44.37 min) than in the gasless TA group (191.01±55.90 min) (p＜0.001). The mean postoperative pain Visual Analogue Scale scores in the UABA with gas group were 2.61±0.96 and 1.85±0.79, respectively, and those in the gasless TA group were 3.12±1.02 and 2.17±0.76, respectively, at 1 and 3 days after surgery. Incidences of postoperative complications were similar except for the higher rate of seroma in the gasless TA group. Cosmetic satisfaction scores of UABA with gas were higher than those of the gasless TA. Conclusion UABA with gas may be a good option for endoscopic thyroidectomy because this approach is less invasive than the gasless TA is. Key words: Endoscopy ㆍ Surgery ㆍ Thyroidectomy

Robotic Lateral Neck Dissection by a Gasless Unilateral Axillobreast Approach for Differentiated Thyroid Carcinoma

The aim of this study was to determine the technical feasibility and intraoperative safety of robotic lateral neck dissection in differentiated thyroid carcinoma (DTC). We analyzed 12 patients with DTC who underwent robotic total thyroidectomy and lateral selective neck dissection by a gasless unilateral axillobreast approach. The procedure was completed successfully in all patients. The mean console time for robotic lateral neck dissection was 54.2 ± 21.5 minutes. Transient hypoparathyroidism occurred in 5 patients, and transient recurrent laryngeal nerve palsy and chyle leak occurred in 1 patient each. Cosmetic satisfaction was excellent in all patients. Robotic lateral neck dissection by a gasless unilateral axillobreast approach for DTC is feasible and safe and allows for excellent postoperative cosmesis in preliminary results. Further studies are needed to establish oncologic safety and surgical completeness compared with conventional neck dissection.

Long-Term Cosmetic Outcomes After Robotic/Endoscopic Thyroidectomy by a Gasless Unilateral Axillo-breast or Axillary Approach

Although the excellent short-term cosmesis after robotic/endoscopic thyroidectomy has been reported, the long-term cosmetic outcome is not yet known. The aim of this study was to evaluate the long-term cosmetic outcome of robotic/endoscopic thyroidectomy. We compared 147 patients who underwent robotic or endoscopic thyroidectomy using a gasless unilateral axillo-breast (GUAB) approach or a gasless unilateral axillary (GUA) approach with 161 conventional open thyroidectomy patients. Subjective cosmetic outcomes were evaluated using a series of scar-specific questions as well as the Vancouver scar scale at 12-18 months after surgery. The cosmetic satisfaction score was defined as the sum of the two cosmetic satisfaction questions with a rating scale of 1-5. The scar consciousness score was defined as the sum of the four scar consciousness questions with a rating scale of 0-3. The cosmetic satisfaction and scar consciousness scores were significantly better in the robotic/endoscopic group than in the open group (P<.001 in both). The cosmetic satisfaction and scar consciousness scores were the same in the robotic and endoscopic groups and were also the same in the GUA and GUAB approach groups. Patients treated by the GUA approach were more satisfied with their scarless breasts than patients treated by the GUAB approach having breast scars. Long-term postoperative cosmesis after robotic/endoscopic thyroidectomy using GUAB/GUA approaches is significantly better than conventional open thyroidectomy. In the robotic/endoscopic group, the scarless breasts resulting from the GUA approach lead to greater satisfaction than those after the GUAB approach.

A cervical vagal schwannoma mimicking a parathyroid cyst.

Cervical vagal schwannomas with cystic degeneration changes are extremely rare. These tumors are typically benign and slow growing. A 44-year-old woman underwent complete resection of a tumor measuring 4×3.5 cm in the right neck using the endoscopic approach, instead of the conventional transcervical approach. We applied the new scarless neck surgery technique with an endoscopic unilateral axillo-breast approach. The tumor originated from the right vagus nerve, and was confirmed to be a vagal schwannoma pathologically. The patient has been followed up for 18 months postoperatively with no evidence of tumor recurrence or neurological deficit. We report an extremely rare vagal schwannoma with cystic degeneration that was removed by an endoscopic approach, along with a review of the relevant literature.

Robot-assisted thyroidectomy: early experience.

The numbers of thyroid surgeries have been increasing recently. Robot-assisted thyroidectomy allows for a better cosmetic outcome in comparison with conventional open thyroidectomy. We performed two robot-assisted endoscopic thyroidectomies by a gasless unilateral axillo-breast approach using the da Vinci surgical robot system. We performed right thyroid lobectomies in both patients. The pathologic reports were: micropapillary carcinoma without extracapsular invasion in patient 1 and a benign cyst in patient 2. The operation times were 165 minutes in patient 1 and 110 minutes in patient 2. No postoperative complications occurred. Regarding our early experience, robotic thyroidectomy using the gasless axillo-breast approach is a safe, feasible, and cosmetically good procedure.

New endoscopic thyroidectomy via a unilateral axillo‐breast approach with gas insufflation: Preliminary report

Invasiveness of endoscopic thyroidectomy has been in debate. The purpose of this study was to introduce new endoscopic thyroidectomy via a unilateral axillo-breast approach (UABA) with gas insufflation to lessen invasiveness. We performed 68 cases of hemithyroidectomy via a UABA with gas insufflation from January to July 2011. The following variables were studied: operation time, pain score, drainage amount, drainage day, perioperative complications, pathological outcomes, and cosmetic satisfaction. Mean postoperative pain visual analogue scale (VAS) scores were 2.75 ± 0.93 and 2.07 ± 0.79 at 1 and 3 days after surgery. The mean amount of drainage over the first 3 postoperative days was 144.35 ± 51.64 mL, and the mean time to drain removal was 3.75 ± 0.81 days. Two cases (2.9%) of transient vocal cord palsy and 2 cases (2.9%) of seroma were identified. All patients were satisfied with the cosmetic results. Endoscopic thyroidectomy via a UABA with gas insufflation is a feasible and less invasive option for selected patients.

Functional voice and swallowing outcomes after robotic thyroidectomy by a gasless unilateral axillo-breast approach: comparison with open thyroidectomy

Voice and swallowing alterations are common complaints after thyroidectomy, even in the absence of laryngeal nerve impairment. However, voice and swallowing functions after robotic thyroidectomy have not been thoroughly investigated. This study compared the functional outcomes for voice and swallowing after robotic thyroidectomy and conventional open thyroidectomy. The study prospectively analyzed the voice and swallowing functions of patients with thyroid nodules who underwent robotic thyroidectomy by a gasless unilateral axillo-breast (GUAB) approach (50 cases) or by conventional open thyroidectomy (61 cases) from September 2009 to October 2010. Videolaryngostroboscopy or flexible laryngoscopy was performed pre- and postoperatively. Subjective voice and swallowing alterations were assessed by questionnaire preoperatively and then 1 day, 1 week, 1 month, 3 months, and 6 months postoperatively. In addition, objective acoustic voice analysis was performed using a Multidimensional Voice Program, with Voice Range Profiles and maximum phonation times measured preoperatively and then 1 week, 1 month, 3 months, and 6 months postoperatively. Subjective postoperative voice function was significantly better in the robotic group at 1 day, 1 month, and 3 months postoperatively than in the open group. The mean values of fundamental frequency, jitter, shimmer and noise-to-harmonic ratio before and after surgery did not differ between the two groups. However, the frequency range and the highest frequency were significantly better in the robotic group than in the open group at 3 months postoperatively. Subjective swallowing function did not differ between the two groups. Postoperative voice function is better with robotic thyroidectomy using the GUAB approach than with conventional open thyroidectomy. This is an advantage of robotic thyroidectomy by the GUAB approach in addition to the excellent cosmesis.

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.

Clipless and sutureless endoscopic thyroidectomy using only the harmonic scalpel

The harmonic scalpel (HS) has been used in endoscopic thyroidectomy with encouraging results. However, additional instruments are frequently required to complete hemostasis. The current study aimed to assess the safety and efficacy of the clipless and sutureless technique using the HS in endoscopic thyroidectomy without supplementary instrumentation. A total of 114 patients underwent endoscopic hemithyroidectomy (HT) or total thyroidectomy (TT) via a unilateral axillo-breast approach. In all cases, hemostasis was achieved solely by the HS. Perioperative complications, surgery-related outcomes, and pathologic outcomes were examined. The operating time in the TT group (170.23 +/- 45.63 min; n = 22) was longer than in the HT group (111.63 +/- 38.44 min; n = 92; p = 0.0000). After the first 50 cases, the operating time decreased significantly (145.60 +/- 52.72 min vs. 105.23 +/- 30.14 min, p = 0.0000). Postoperative minor hematomas from the skin flap were experienced by three patients (3.3%) in the HT group. No postoperative hemorrhage or hematoma was noted in the thyroidectomy field using the HS. Four patients in the HT group (4.3%) and one patient in the TT group (4.5%) experienced transient unilateral vocal cord palsy. Temporary hypocalcemia was observed in eight patients in the TT group (36.4%). No permanent recurrent laryngeal nerve palsy or hypoparathyroidism occurred in either group. The HS alone in clipless and sutureless endoscopic thyroidectomy provides a good alternative to the conventional ligation or clipping technique because it is associated with a shorter operating time and a relatively low incidence of complications.

Endoscopic hemithyroidectomy with prophylactic ipsilateral central neck dissection via an unilateral axillo-breast approach without gas insufflation for unilateral micropapillary thyroid carcinoma: preliminary report

Recently, various endoscopic approaches have been applied to thyroid surgery. However, few specific data exist on endoscopic thyroidectomy with central neck dissection (CND) for micropapillary thyroid carcinoma. This study aimed to evaluate the feasibility and safety of endoscopic hemithyroidectomy (HT) plus CND. In this study, 29 consecutive patients underwent endoscopic HT with ipsilateral CND via a unilateral axillo-breast approach (endo group), and 30 matched control patients underwent conventional open HT with ipsilateral CND (open group). The following variables were compared between these two groups: perioperative complications, surgery-related outcomes, and pathologic outcomes. The operating time in the endo group was longer than in the open group (p = 0.012). In terms of parathyroid gland (PTG) preservation, there were no statistically significant differences between the two groups. The mean numbers of dissected central lymph nodes and metastatic central lymph nodes were similar in the two groups (p = 0.506 vs. 0.975). The endo group had a significantly longer mean hospital stay (6.21 +/- 0.94 days) than the open group (4.30 +/- 1.02 days; p = 0.000). No significant difference was observed in the overall perioperative complications between the two groups. This study demonstrates that the endoscopic approach of CND plus HT is feasible for selected unilateral, intrathyroidal, micropapillary carcinomas. In the future, prospective and comparative studies on the surgical techniques of total thyroidectomy and CND are needed to verify their oncologic safety.

Endoscopic thyroidectomy via a unilateral axillo-breast approach without gas insufflation for unilateral benign thyroid lesions

The usefulness of various endoscopic thyroid surgery techniques has been reviewed. Recently, the authors developed a unilateral axillo-breast approach for endoscopic hemithyroidectomy to minimize the visible scar in a natural position and to overcome the limitation of instrumentation. The feasibility and safety of endoscopic thyroid surgery was examined via a novel approach without gas insufflation. This study enrolled 52 consecutive patients undergoing endoscopic hemithyroidectomy via a unilateral axillo-breast approach without gas insufflation. A skin incision parallel to the skin crease was made in the axillary fossa for insertion of a 10-mm 30 degrees rigid endoscope and endoscopic instruments. To create a working space, an external retractor was inserted through the skin incision in the axilla and raised using a lifting device. A second 1.0-cm skin incision was made along the upper margin of the mammary areola on the tumor side for insertion of a 12-mm trocar. Postoperative pathology showed 11 follicular adenomas, 1 follicular carcinoma, and 40 benign thyroid lesions. The operating time for the first 10 hemithyroidectomies was 154 +/- 64.88 min, which was 34.77 min longer than for the last 42 hemithyroidectomies (119.23 +/- 31.47 min; p = 0.1314). The amount of postoperative drainage was 236.63 +/- 118.67 ml, and the duration of drainage was 4.54 +/- 1.42 days. The postoperative hospital stay was 6.37 +/- 2.83 days. Overall, seven patients (7/52, 13.5%) experienced perioperative complications, including one transient recurrent laryngeal nerve palsy (1.9%), five seromas (9.6%), and one hematoma (1.9%), which arose from a subplatysmal skin flap. Although the aspect of invasiveness could be improved, endoscopic hemithyroidectomy via a unilateral axillo-breast approach without gas insufflation is safe and effective and appears to provide better cosmetic results and a shorter operation time than other endoscopic methods for managing selective unilateral benign thyroid lesions.