Long-term result of hybrid-type endoscopic thyroidectomy (HET) for differentiated thyroid carcinoma including novel single-incision endoscopic thyroidectomy (SIET) to testify curability

Masayuki Tori, MD, PhD¹, Katsuhide Yoshidome, MD, PhD¹, Toshirou Shimo, MD, PhD¹, Kana Anno, MD¹, Hiroki Akamatsu, MD, PhD², Masahiro Tanemura, MD, PhD², Kentarou Kishi, MD, PhD², Mitsuyoshi Tei, MD, PhD², Toru Masuzawa, MD, PhD², Masaki Wakasugi, MD², Youzou Suzuki, MD, PhD², Kenta Furukawa, MD, PhD², Toshiki Takahashi, MD, PhD³. ¹Endocrine surgery, Osaka Police Hospital, ²Digestive surgery, ³Cardiovascular surgery

Background and Aim: Pure endoscopic thyroidectomy (ET) for differentiated thyroid cancer (DTC) could not be standardized because of incompatibility to enough lymph node dissection and invasive cases including invasion to the trachea. To overcome these important issue, we already developed hybrid-type endoscopic thyroidectomy (HET: Tori’s method; Surg Endosc 2014), combining ET and small skin incision surgery. As further step, we have developed single-incision endoscopic thyroidectomy (SIET) for thyroid carcinoma. To examine curability, we present long-term result of HET (including SIET) comparing with traditional thyroid surgery for carcinoma.

Patients and methods: For the past 7 years, total number of DTC was 754 which were performed thyroidectomy (total and lobectomy with lymph node dissection). Among them, HET was performed for 323 ceases (SIET for 35 patients who chosed). As to the operative indication for HET, tumor size is <4cm, with or without tracheal invasion needing shaving. These 754 cases were clinically examined retrospectively. Evaluation of cosmetics and pain scale were added to the results. (Op procedures of SIET) Single small color incision (1.5-2.0cm) is made just above the clavicle of the tumor side, both in lobectomy and total thyroidectomy. Before SIET port is attached to the incision, central lymph node dissection is performed. To obtain enough working space, anterior neck muscles are divided longitudinally at the midline, and after dissection of the space between thyroid and the muscles, both side of the anterior muscles are pulled toward each side supported by L-shaped steel lift fixed to the edge of the operating table. Three 5mm trocars are inserted on the SILS port. By using some useful retractors, recurrent nerve and parathyroids are clearly visible, and finally lobectomy or total thyroidectomy can be done. Result: All of the operative cases are alive. As to the recurrence and metastasis, only 2 cases had LN metastasis and reoperation was performed, in HET group (average follow-up 39 months), on the other hand, 3 cases suffered from LN metastasis, 2 cases recurrence in the residual lobe, and 2 cases lung metastasis in the traditional op group (average follow-up 42 months).

Conclusion: Our findings support the idea that HET ( including SIET ) is a feasible, practical, and safe procedure, with excellent cosmetic benefits as well as curability.