Video-assisted Endoscopic Thyroidectomy with Cervical Approach

Kim, Jae Won; Kim, Dae Hyung; Cho, Byung Han; Kim, Bo Mook; Kim, Young Mo

Abstract

BACKGROUND AND OBJECTIVES
Endoscopic approach to the neck is more widely used since it was first reported by M.Gagner in 1996, because of its low invasiveness and better cosmetic result. In this article, we introduce a surgical technique of video-assisted endoscopic thyroidectomy via cervical approach and assess its efficacy for patients with thyroid nodule. SUBJECTS AND METHOD: Eleven patients hospitalized in our department from May to September 2004, underwent video-assisted thyroidectomy with cervical approach. The subjects were 9 women and 2 men with ages ranging from 23 to 62 year old (mean 40.9 years). Inclusion criteria for the subjects were having benign solitary tumor that is less than 30 mm in longitudinal diameter, low risk micropapillary carcinoma that is less than 1 cm, confined to one lobe, within the thyroid gland, and without lymph node swelling on ultrasonography or computed tomography, and follicular neoplasm that is without evidence of any malignancy or with suspicious and indeterminate cytology among patients with no prior neck surgery or previous radiotherapy. Most patients (82%) had thyroid mass less than 2 cm. Nodular hyperplasia was 7 cases and papillary carcinoma was 4 cases. RESULTS: Hemithyroidectomy with or without isthmusectomy was performed in 10 patients. Video-assisted thyroidectomy was converted into conventional thyroidectomy in only one case because of the uncontrolled intraoperative superior thyroid artery bleeding and large thyroid volume. The operation time was 80+/-12 minutes. Temporary recurrent laryngeal nerve palsy occurred in one case. The average postoperative hospital stay was 5.0+/-1.8 days. Operative scars were small and most patients were satisfied with the cosmetic result. CONCLUSION: We conclude that the video-assisted endoscopic thyroidectomy with cervical approach is feasible, practical, and has safe procedures, and has greater cosmetic benefits than the conventional one. We hope that video-assisted thyroidectomy will become another surgical option for small nodular thyroid diseases.