Gasless Endoscopic Thyroidectomy via an Anterior Chest Wall Approach Using a Flap-Lifting System

Abstract

PurposeEndoscopic thyroidectomy (ET) requires a proper working space for adequate visualization of anatomical structures and proper instrument manipulation. The purpose of this prospective study was to estimate the feasibility and safety of ET using an anterior chest wall approach without gas insufflation.Materials and MethodsThe working space was created under a direct and endoscopic view through a 3-cm incision on the anterior chest wall. A retracting device was then inserted to establish the working space, and subsequent procedures were performed endoscopically. All data were reviewed using a prospective database.ResultsWe performed 30 ETs in patients with benign thyroid tumors from December 2003 to December 2005. The procedures were completed successfully in 29 patients (mean operative time: 160.6 min; range: 90-345 min). One patient with ET was converted to open thyroidectomy secondary to substernal extension of the tumor. None of the patients developed permanent postoperative hypocalcemia or recurrent laryngeal nerve paralysis. Three patients exhibited some degree of transient recurrent laryngeal nerve palsy.ConclusionThese data suggest that gasless ET using an anterior chest wall approach is safe and feasible in selected patients for treating benign thyroid tumors. This technique may offer good operative working space when performed by surgeons with relatively low-volume ET practices.

Extracervical approaches to endoscopic thyroid surgery

“…Arterial and venous injuriesprobably due to inadequate experience with the endoscopic instrumentation-can occur. Other complications common to all thyroid surgery have been reported, such as hypocalcemia, recurrent laryngeal nerve palsy, seroma, hematoma, and postoperative infection [33,38,39,49,50]. The most severe complications were observed mainly in the first attempts of endoscopic surgery [4], while newer studies have revealed milder or even no complications [17,[39][40][41][42][43].…”

“…The applications of these approaches are summarized in Table 1 [12,[23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40]. With these new techniques the scars are not necessarily smaller than the ones in the neck, but they have been ''shifted'' to an area that is covered by clothing.…”

“…The most commonly used noncervical approaches are the axillary approach [12,[23][24][25][26][27][28], the anterior/breast approach [29][30][31][32][33], the lateral approach [34,35], and also some hybrid approaches [36][37][38][39][40] such as the axillary-bilateral breast approach (ABBA), bilateral axillo-breast approach (BABA), the unilateral axillo-breast approach, and the postauricular and axillary approach. The applications of these approaches are summarized in Table 1 [12,[23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40].…”

New Technologies in Thyroid Surgery

“…Several investigators have described totally endoscopic approaches to the thyroid compartment [88][89][90][91][92][93][94]. Early totally endoscopic approaches described by Ikeda and colleagues [88] used three ports located in the axillary region with low-pressure insufflation.…”

Robotic Surgery in Otolaryngology: Endocrine

“…Endoscopic techniques evolved first in the field of parathyroid surgery [1 • ]. Significant improvements in endoscopic instrumentation, preoperative localization studies, and the increased understanding of the endoscopic cervical anatomy have facilitated the further growth of head and neck endoscopic surgery for the management of thyroid and parathyroid disease [2][3][4][5][6][7][8][9].…”