World Journal of Surgery

, Volume 41, Issue 10, pp 2649–2650 | Cite as

Strategy to Prevent Subcutaneous Emphysema and Gas Insufflation-Related Complications in Transoral Endoscopic Thyroidectomy Vestibular Approach: Reply

  • Angkoon Anuwong
Reply, Letter to the Editor

Dear Editor,

Various approaches to endoscopic and robotic thyroidectomy have been developed over the last two decades in order to reduce or avoid the formation of scarring on the anterior neck, which is a concern for patients, especially Asians. Generally, carbon dioxide (CO2) is used as gas insufflation in most laparoscopic procedures, including endoscopic and robotic thyroidectomy. With the benefit of inertia, non-inflammable, absorbable in circulation and then excreted by exhalation, CO2 is ideal for laparoscopic gas insufflation [1]. In laparoscopic abdominal surgery, the gas is insufflated into the abdominal cavity and rarely causes any major problems. However, endoscopic thyroidectomy is performed by creating an unnatural working space between the muscles and subcutaneous fat of the neck area. As a result, subcutaneous emphysema may develop with inappropriate settings [2, 3, 4].

Subcutaneous emphysema has been defined as having air tapping in the subcutaneous fat and can be...


Goiter Subcutaneous Emphysema Endoscopic Thyroidectomy Robotic Thyroidectomy Mediastinal Emphysema 
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.


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.


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Copyright information

© Société Internationale de Chirurgie 2017

Authors and Affiliations

  1. 1.Minimally Invasive and Endocrine Surgery Division, Department of SurgeryPolice General HospitalBangkokThailand

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