Endoscopic thyoridectomy by the axillary approach

Aim: Minimally invasive surgery is widely employed for the treatment of thyroid diseases. We have performed pure endoscopic thyroidectomy by the axillary approach from 1999. In this study, we evaluate the efficacy of this surgical procedure.
Patients and Methods: The indications for this procedure included the presence of a follicular nodule or adenomatous goiter with a maximum diameter of less than 6cm as observed during a preoperative ultrasonography examination and small low-risk papillary thyroid carcinomas. Our procedure is pure endoscopic thyroidectomy with carbon dioxide insufflation from an axillary portion. This procedure was performed in 122 cases including 7 papillary thyroid carcinomas.
Results: Conversion was necessary in three cases (difficult dissection in two cases and large nodule size in one case). Thyroid partial recection was successfully accomplished in 21 cases, thyroid lobectomy in 93 cases and subtotal thyroidectomy in 5 cases. A subtotal thyroidectomy was performed for cases of Graves’ disease. Unilateral central neck lymph node dissection was completed in 5 cases without any complications. Major vessel bleeding such as superior or inferior thyroid artery during surgery was 2 cases, however, these complications were able to be controlled in endoscopic procedure and completed the endoscopic purocedure. The operative time and the amount of bleeding were statistically significantly reduced, as the surgeon gained experience with the technique. The mean operative time for a thyroid lobectomy in the last year was 155 minutes. Postoperative complications included 3 transient recurrent nerve palsies, and 1 postoperative arm pain. The cosmetic result was excellent and almost all patients are satisfied with the results.
Conclusion: The indications for pure endoscopic thyroidectomy are still limited. Nonetheless, in selected patients, it seems a valid option for thyroidectomy and even preferable to conventional surgery because of its significant advantages, especially in terms of cosmetic result.

Session: Podium Presentation

Program Number: S055

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