Endoscopic thyroidectomy using a new bilateral axillo-breast approach

被引:320
作者
Choe, Jun-Ho
Kim, Seok Won
Chung, Ki-Wook
Park, Kyoung Sik
Han, Wonshik
Noh, Dong-Young
Oh, Seung Keun
Youn, Yeo-Kyu [1 ]
机构
[1] Seoul Natl Univ Hosp, Dept Surg, Seoul 110744, South Korea
[2] Natl Canc Ctr, Goyangsi, Gyeonggido, South Korea
关键词
D O I
10.1007/s00268-006-0481-y
中图分类号
R61 [外科手术学];
学科分类号
摘要
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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页码:601 / 606
页数:6
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