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Increasing the size limit of benign thyroid lesions resectable by endoscopic thyroidectomy via a unilateral axillo-breast approach without gas insufflation

 Won Shik Kim  ;  Hyun Jun Hong  ;  Yoo Seob Shin  ;  Eun Chang Choi  ;  Hong-Shik Choi  ;  Yoon Woo Koh 
 WORLD JOURNAL OF SURGERY, Vol.35(10) : 2203-2211, 2011 
Journal Title
Issue Date
Adolescent ; Adult ; Axilla ; Breast ; Endoscopy* ; Feasibility Studies ; Female ; Humans ; Insufflation ; Male ; Middle Aged ; Retrospective Studies ; Thyroid Neoplasms/pathology* ; Thyroid Neoplasms/surgery* ; Thyroidectomy/methods* ; Young Adult
BACKGROUND: Endoscopic thyroidectomy is rarely attempted in patients with large goitrous lesions. We examined the feasibility and safety of endoscopic thyroidectomy via a unilateral axillo-breast approach without gas insufflation for resection of large thyroid tumors (≥4 cm). METHODS: The study included 111 patients: 82 in group 1 (tumor diameter <4 cm) and 29 in group 2 (≥ 4 cm). Ninety-one patients underwent hemithyroidectomy and 20 underwent total thyroidectomy. Local complications, surgical outcomes, and pathological outcomes were compared between groups. RESULTS: Postoperative permanent pathology revealed 24 follicular adenomas and 87 nodular hyperplasias. The mean tumor size in group 2 was 51.10 ± 7.66 mm compared to 25.24 ± 8.14 mm in group 1. The mean volume of the thyroid gland in group 2 was 15.60 ± 3.45 cm(3) compared to 11.27 ± 2.40 cm(3) in group 1 (p = 0.000). Mean operating time did not differ significantly between groups (p = 0.520). Postoperatively, minor hematomas were encountered in three patients (3.7%) in group 1. Three patients in group 1 (3.7%) and two in group 2 (6.9%) developed transient unilateral vocal cord palsy (p = 0.604). Temporary hypocalcemia was observed in six and one patients in groups 1 and 2, respectively (p = 1.000). No permanent recurrent laryngeal nerve palsy or hypoparathyroidism occurred in either group. CONCLUSION: Our data support the safety and feasibility of endoscopic thyroidectomy via a unilateral axillo-breast approach without gas insufflation, even for the treatment of benign thyroid lesions ≥4 cm.
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1. College of Medicine (의과대학) > Dept. of Otorhinolaryngology (이비인후과학교실) > 1. Journal Papers
Yonsei Authors
Kho, Yoon Woo(고윤우)
Kim, Won Shik(김원식)
Shin, Yoo Seob(신유섭)
Choi, Eun Chang(최은창)
Choi, Hong Shik(최홍식)
Hong, Hyun Jun(홍현준)
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