Korean J Endocr Surg.  2017 Mar;17(1):19-24. 10.16956/kaes.2017.17.1.19.

Endoscopic Thyroidectomy Via the Cervico-axillary Approach for Thyroid Cancer: Initial Experience in a Single Institute

• An JS
• Kim HG
• Paek SH
• Lee JW
• Woo J
• Kwon H
• Lim W
• Moon BI
• Paik NS

• KMID: 2397988
• DOI: http://doi.org/10.16956/kaes.2017.17.1.19

Abstract

PURPOSE
Endoscopic thyroidectomy using a cervico-axillary approach (CAA) provides optimal visualization with a smaller dissection plane. Despite the excellent cosmetic results and high patient satisfaction, the surgical and oncologic safety of CAA endoscopic surgery has not been fully established. The present study evaluated the feasibility, safety, and surgical outcomes of CAA endoscopic thyroidectomy.
METHODS
From October 2009 to April 2012, 100 patients with papillary thyroid cancer underwent CAA endoscopic thyroidectomy. Patient demographics, pathologic features, and surgical outcomes including complications and recurrence were collected.
RESULTS
CAA endoscopic thyroidectomy was successful in all patients, and none required conversion to open thyroidectomy. All patients underwent ipsilateral thyroid lobectomy with or without central compartment neck dissection. The mean tumor size was 1.0±0.6 cm (range, 0.5~1.6), and 35.0% of tumors showed extrathyroidal extension. The mean number of harvested lymph nodes was 4.1±4.4, and metastasis was found in 12.0% of patients. The mean surgical time was 175.2±50.4 min, mean intraoperative blood loss was 42.5±69.2 ml, and the mean hospital stay was 3.3±0.6 days. There were five cases of postoperative transient hypocalcemia and eight cases of vocal cord palsy. No permanent complication or postoperative bleeding was observed. Patients continued to be seen for a median period of 63.7 months, and no recurrence of thyroid cancer was seen.
CONCLUSION
CAA endoscopic thyroidectomy is a feasible and safe procedure for low-risk thyroid cancer, with excellent cosmesis. It can be recommended as an alternative option for selected patients with low-risk thyroid cancer.

Keyword

Cervico-axillary approach; Endoscopic thyroidectomy; Thyroid neoplasms

MeSH Terms

Demography
Hemorrhage
Humans
Hypocalcemia
Length of Stay
Lymph Nodes
Neck Dissection
Neoplasm Metastasis
Operative Time
Patient Satisfaction
Recurrence
Thyroid Gland*
Thyroid Neoplasms*
Thyroidectomy*
Vocal Cord Paralysis

Figure

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  Fig. 1 Position of endoscopic trocars at operation.

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  Fig. 2 Operative view after CAA endoscopic thyroidectomy. CAA = cervico-axillary approach.

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  Fig. 3 Postoperative neck scar after CAA endoscopic thyroidectomy. CAA = cervico-axillary approach.

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