Endoscopic thyroidectomy using a new bilateral axillo-breast approach

Jun Ho Choe, Seok Won Kim, Ki Wook Chung, Kyoung Sik Park, Wonshik Han, Dongyoung Noh, Seung Keun Oh, Yeo Kyu Youn

Research output: Contribution to journalArticle

196 Citations (Scopus)

Abstract

Introduction: Endoscopic techniques have recently been applied in thyroid surgery using cervical, axillary, and breast approaches. We modified the axillo-bilateral breast approach (ABBA) and developed the bilateral axillo-breast approach (BABA) to obtain optimal visualization for total thyroidectomy. Methods: We used two 12-mm ports through bilateral circumareolar incisions for flexible videoscopy and Harmonic scalpel and two 5-mm ports through both axillae for graspers and dissectors. Thyroidectomy was performed under full visualization of the superior and inferior thyroidal arteries, parathyroid glands, and recurrent laryngeal nerves. Results: After performing 25 ABBA endoscopic thyroid surgeries, we developed BABA and performed 110 operations using this method. The BABA operations included 52 total thyroidectomies, 2 near-total thyroidectomies, 8 subtotal thyroidectomies, 43 lobectomies, and 3 subtotal lobectomies. Pathology revealed 41 benign lesions and 69 cancers. Mean operation time was 165.3 ± 43.5 minutes. There were 2 cases of conversion to open surgery, 1 due to cancer with capsular invasion and the other due to tracheal injury. Nine postoperative complications developed: transient unilateral vocal cord palsy in 4 cases, transient hypocalcemia in 4 cases, and postoperative infection in 1 case. The 2-month postoperative thyroglobulin level was less than 1 ng/ml in all examined cases of total thyroidectomy. Cosmetic results were excellent. Conclusions: The BABA technique for endoscopic thyroid surgery is a feasible method of total thyroidectomy with a low rate of postoperative complications and, additionally, excellent cosmetic results. Therefore, in selected cases of thyroid cancer, the BABA endoscopic total thyroidectomy should be considered as a valid surgical option.

Original languageEnglish
Pages (from-to)601-606
Number of pages6
JournalWorld Journal of Surgery
Volume31
Issue number3
DOIs
StatePublished - 1 Mar 2007

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Thyroidectomy
Breast
Thyroid Gland
Cosmetics
Conversion to Open Surgery
Recurrent Laryngeal Nerve
Vocal Cord Paralysis
Axilla
Parathyroid Glands
Hypocalcemia
Thyroglobulin
Thyroid Neoplasms
Neoplasms
Arteries
Pathology
Wounds and Injuries
Infection

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Choe, Jun Ho ; Kim, Seok Won ; Chung, Ki Wook ; Park, Kyoung Sik ; Han, Wonshik ; Noh, Dongyoung ; Oh, Seung Keun ; Youn, Yeo Kyu. / Endoscopic thyroidectomy using a new bilateral axillo-breast approach. In: World Journal of Surgery. 2007 ; Vol. 31, No. 3. pp. 601-606.
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abstract = "Introduction: Endoscopic techniques have recently been applied in thyroid surgery using cervical, axillary, and breast approaches. We modified the axillo-bilateral breast approach (ABBA) and developed the bilateral axillo-breast approach (BABA) to obtain optimal visualization for total thyroidectomy. Methods: We used two 12-mm ports through bilateral circumareolar incisions for flexible videoscopy and Harmonic scalpel and two 5-mm ports through both axillae for graspers and dissectors. Thyroidectomy was performed under full visualization of the superior and inferior thyroidal arteries, parathyroid glands, and recurrent laryngeal nerves. Results: After performing 25 ABBA endoscopic thyroid surgeries, we developed BABA and performed 110 operations using this method. The BABA operations included 52 total thyroidectomies, 2 near-total thyroidectomies, 8 subtotal thyroidectomies, 43 lobectomies, and 3 subtotal lobectomies. Pathology revealed 41 benign lesions and 69 cancers. Mean operation time was 165.3 ± 43.5 minutes. There were 2 cases of conversion to open surgery, 1 due to cancer with capsular invasion and the other due to tracheal injury. Nine postoperative complications developed: transient unilateral vocal cord palsy in 4 cases, transient hypocalcemia in 4 cases, and postoperative infection in 1 case. The 2-month postoperative thyroglobulin level was less than 1 ng/ml in all examined cases of total thyroidectomy. Cosmetic results were excellent. Conclusions: The BABA technique for endoscopic thyroid surgery is a feasible method of total thyroidectomy with a low rate of postoperative complications and, additionally, excellent cosmetic results. Therefore, in selected cases of thyroid cancer, the BABA endoscopic total thyroidectomy should be considered as a valid surgical option.",
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Endoscopic thyroidectomy using a new bilateral axillo-breast approach. / Choe, Jun Ho; Kim, Seok Won; Chung, Ki Wook; Park, Kyoung Sik; Han, Wonshik; Noh, Dongyoung; Oh, Seung Keun; Youn, Yeo Kyu.

In: World Journal of Surgery, Vol. 31, No. 3, 01.03.2007, p. 601-606.

Research output: Contribution to journalArticle

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