Endoscopic Thyroidectomy by Axillary Approach : First Consecutive 6 Cases in Rajavithi Hospital
Background: Transverse surgical scar after conventional thyroidectomy is one of the unavoidable problem. Endoscopic thyroidectomy performed via the axillary approach leaves no scaring of the neck and anterior chest wall thus provides an excellent cosmetic results. The axillary scars usually are not seen in normal arm position.
Methods: From 10th April 2001 - 31st May 2001, we performed 6 cases of lobectomy and isthmectomy by this technique. One 10-mm port for semi-rigid endoscope and three 5-mm ports for instruments and suction were inserted on the same side of diseased thyroid lobe. The CO2- insufflation pressure was set below 4-mmHg and dissection mainly using an ultrasonically activated shears.
Results: All 6 patients were success fully performed with no conversion to conventional technique. Mean operating time was 253 minutes and blood loss was 143 ml. Recurrent laryngeal nerves were clearly identified in every case and no voice changes after surgery was observed. One case developed a 20 ml seroma on 10th postoperative day and was treated by simple aspiration. The patients were discharged at 6.3 postoperative day by average.
Conclusion: Endoscopic thyroidectomy by axillary approach for benign thyroid diseases are feasible, safe with better cosmetic results.
2. Brunt LM, Jones DB, Wu JS, et al. Experimental development of an endoscopic approach to neck exploration and parathyroidectomy. Surgery 1997; 122: 893901.
3. Gagner M. Endoscopic subtotal parathyroidectomy in patients with primary hyperparathyroidism. Br J Surg 1996; 83:875.
4. Miccoli P, Pinchera A, Cecchini G, et al. Minimally invasive, video-assisted parathyroid surgery for primary hyperparathyroidism, J Endocrinol Invest 1997; 20: 429-30.
5. Brunt LM, Brunt EM, Jones DB. Endoscopic axillary lymph node dissection in a human cadaver model. J Am Coll Surg 1998;187:158-63.
6. Malur S, Bechler J, Schneider A. Endoscopic Axillary lymphadenectomy without prior liposuction in 100 patients with invasive breast cancer. Surg Laparosc Endosc Percutan Tech 2001; 11:38-41.
7. Liem MS, Graaf Y, Steensel CJ, et al. Comparison of conventional anterior surgery and Iaparoscopic surgery for inguinal hernia repair. N Engl J Med 1997;336:1541-7.
8. Brunt LM, Molmenti EP, Kerbl K, et al. Retroperitoneal endoscopic adrenalectomy: an experimental study. Surg Laparosc Endosc 1993; 3: 303-6.
9. Mercan S, Seven R, Ozarmagan S, Tezelman S. Endoscopic retroperitoneal adrenalectomy. Surgery 1995; 118: 1071-6,
10. Ikeda Y, Takami H, Sasaki Y, et al. Endoscopic neck surgery by the axillary approach. J Am Coll Surg 2000; 191: 336-40.
11. Ikeda Y, Takami H, Sasaki Y, et al. Endoscopic resection of thyroid tumors by the axillary approach, J Cardiovasc Surg 2000;41:791-2.
12. Gottlieb A, Sprung J, Zhang XM, Gagner M. Massive subcutaneous emphysema and severe hypercarbia in a patient during endoscopic transcervical parathyroidectomy using carbon dioxide insufflation. Anesth Analg 1997; 84:1154-6.
13. Rubino F, Pamoukian VN, Zhu JF, et al. Endoscopic endocrine neck surgery with carbon dioxide insufflation: The effect on intracranial pressure in a large animal model. Surgery 2000;128: 1035-42.
14. Ochiai R, Takeda J, Noguchi J, et al. Subcutaneous carbon dioxide insufflation dose not cause hypercarbia during endoscopic thyroidectomy. Anesth Analg 2000; 90;760-2.
15. Ohgami M, Ishii s, Arisawa Y, et al. Scarless endoscopic thyroidectomy: breast approach for better cosmesis. Surg Laparosc Endosc Percutan Tech 2000; 10:1-4.
16. Shimizu K, Akira s, Jasmi AY, et al. Video-assisted neck surgery: endoscopic resection of thyroid tumor with a very minimal neck wound. J Am Coll Surg 1999; 188: 697-703.
17. Yeh TS, Jan YY, Hsu BR, et al. Video-assisted endoscopic thyroidectomy. Am J Surg 2000; 180: 82-5.
18. Yeung GHC. Endoscopic surgery of the neck, A new frontier. Surg Laparosc Endosc 1998; 8: 227-32.
19. Yamamoto M, Sasaki A, Asahi H, et al. Endoscopic subtotal thyroidectomy for patients with Grave's disease. Surg Today 2001:31:1-4.
How to Cite
Articles must be contributed solely to The Thai Journal of Surgery and when published become the property of the Royal College of Surgeons of Thailand. The Royal College of Surgeons of Thailand reserves copyright on all published materials and such materials may not be reproduced in any form without the written permission.