Endoscopic Right Lobectomy Axillary-breast Approach: Report of Two Cases

Abstract

Background. We reported our two initial experiences in the treatment of thyroid disease with endoscopic thyroidectomy. Minimally invasive video-assisted technique (MIVAT) was initially introduced by Miccoli. The modification was made by using axillary and breast technique. Method. Two young women patients, with 4 and 5 cm right lobe thyroid disease suspected to be benign. From physical examination, sonography, and FNAB findings, the two cases were categorized as benign. We performed endoscopic right lobectomy through incision of 5-10 mm on axillary line and breast using CO2 insufflation. Result. Duration of first operation was 300 minutes and the second one was 120 minutes, with minimal blood loss and no major complication. Patients were discharged 24 hours after operation. Cosmetic result was excellent. Postoperative complications were shoulder discomfort and neck swelling. Conclusion. We reported two cases of endoscopic right lobectomy as a safe, reproducible technique with an indication in a minority of patients candidates for thyroidectomy and is characterized by less postoperative discomfort.

Feasibility and Safety of Endoscopic Thyroidectomy Via a Unilateral Axillobreast Approach for Unilateral Benign Thyroid Tumor in Vietnam

“…The duration of endoscopic thyroidectomy via pure axillary approach is longer compared with open surgery, MIVAT, and endoscopic procedures via the breast approach, and requires highly skilled surgeons. 10,14,15 At the same time, if the approaches are combined (axillobreast approach), they can make the surgical procedure easier and reduce its duration. 14,22 Studies show that the length of time for surgery via the UABA approach carried out on patients with unilateral colloidal goiter is generally the same as for open surgery, MIVAT, and endoscopic procedures via the breast approach, and less than for endoscopic procedures via the axillary approach.…”

“…The cosmetic effect, in this case, is higher compared with traditional open surgery. [12][13][14][15] Yet, it is insufficient for some patients. The advantage of the axillary approach, or armpit approach, is that it leaves no scars noticeable if the arm is in the proper position, but this method is more complicated, requires highly skilled surgeons, the length of time for the surgery is longer, and the number of complications is often higher compared with open surgery.…”

“…The advantage of the axillary approach, or armpit approach, is that it leaves no scars noticeable if the arm is in the proper position, but this method is more complicated, requires highly skilled surgeons, the length of time for the surgery is longer, and the number of complications is often higher compared with open surgery. 10,14,15 Nevertheless, excellent cosmetic result, the improvement of endoscopic instruments, and skills of surgeons being in constant development are good arguments for the search for the most optimal methods to use this type of access in combination with mammary therapy. Currently, the axillobilateral breast approach 16 and bilateral axillobreast approach 17 are popularly in use, next to the axillarybreast-shoulder approach with gas insufflation.…”

Thyroid and Parathyroid Diseases

“…However, none of these approaches is exclusively advantageous and universally accepted. (Irawati, 2010). The cervical approach and anterior chest approach are minimally invasive, but not cosmetically excellent.…”

Minimally Invasive Thyroidectomy

“…Although some experiences about the breast approach and ABBA methods for MIT are still reported from China and some other Asian countries (Zhang et al 2011 ;Irawati 2010 ) , this approach needs careful modifi cations to gain the wide acceptances from the Western countries.…”