World Journal of Surgery

, 35:2203 | Cite as

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 KohEmail author



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).


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.


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 cm3 compared to 11.27 ± 2.40 cm3 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.


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.


Thyroid Gland Goiter Parathyroid Gland Recurrent Laryngeal Nerve Follicular Adenoma 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



The authors declare that they have no significant financial interest in or affiliation with the manufacturers of products or devices that are discussed in this article.

Supplementary material

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Copyright information

© Société Internationale de Chirurgie 2011

Authors and Affiliations

  • Won Shik Kim
    • 1
  • Hyun Jun Hong
    • 1
  • Yoo Seob Shin
    • 1
  • Eun Chang Choi
    • 1
  • Hong-Shik Choi
    • 1
  • Yoon Woo Koh
    • 1
    Email author
  1. 1.Department of OtorhinolaryngologyYonsei University College of MedicineSeoulKorea

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