Endoscopic Thyroidectomy for Multinodular Goiter

Introduction: Surgery for multinodular goiter disease typically requires a modest cervical incision to access and extract the diseased thyroid gland. Endoscopic thyroid surgery has become increasingly popular as a result of improved visualization of critical anatomy as well as improved overall cosmetic outcome by avoiding the typical cervical neck incision. In an effort to maximize comesis most endoscopic thyroid procedures limit the size of the gland to be removed by limiting the size of the extraction site scar. We recently performed total and near total thyroidectomy for multinodular goiter disease using a combined transaxillary and periareolar endoscopic approach with excellent clinical and cosmetic results.
Methods: There were 22 patients who presented for surgical treatment of benign multinodular goiter disease. There were 19 females and 3 males in this series. Seventeen patients presented clinically with an enlarging thyroid mass resulting in compressive neck symptoms. Five patients complained of cosmetic deformity. All patients underwent surgical thyroidectomy using a combined transaxillary/periareolar endoscopic approach to the thyroid. Sixteen patients underwent total thyroidectomy while the remaining 6 patients had near total thyroid resection.
Results: Endoscopic total or near total thyroidectomy was successfully completed in all patients. No patient required conversion to an open technique. The average weight of the excised gland in this series was 222 grams (range 84 grams – 420 grams). The recurrent laryngeal nerve was identified bilaterally in all patients. There was no recurrent laryngeal nerve injury in any patient. Two patients suffered transient hypocalcemia. Both patients had complete resolution of their hypocalcemic state within a one week time period. All patients reported high satisfaction with their cosmetic results.
Conclusion: Endoscopic thyroidectomy has gradually gained acceptance as an effective tool for the treatment of benign thyroid diseases. Many series report successful outcome using this technique in unilateral disease. However, many diseases of the thyroid require total or near total thyroid resection for adequate treatment. Unilateral techniques such as transaxillary thyroidectomy, may prove challenging in safely approaching the contralateral lobe as a result of inadequate visualization. Combined transaxillary/periareolar endoscopic thyroidectomy allows excellent visualization of ipsilateral as well as contralateral anatomy. Excellent visualization of structures through endoscopic magnification and focused lighting of the anatomic field may result in improved safety for this surgical procedure. Combined transaxillary/periareolar endoscopic thyroidectomy is a safe and effective approach for the surgical treatment of benign multinodular goiter.

Session: Podium Presentation

Program Number: S091

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