Surgical Endoscopy

, 24:188 | Cite as

Endoscopic hemithyroidectomy with prophylactic ipsilateral central neck dissection via an unilateral axillo-breast approach without gas insufflation for unilateral micropapillary thyroid carcinoma: preliminary report

  • Yoon Woo Koh
  • Jae Hong Park
  • Jae Wook Kim
  • Seung Won Lee
  • Eun Chang Choi
Article

Abstract

Background

Recently, various endoscopic approaches have been applied to thyroid surgery. However, few specific data exist on endoscopic thyroidectomy with central neck dissection (CND) for micropapillary thyroid carcinoma. This study aimed to evaluate the feasibility and safety of endoscopic hemithyroidectomy (HT) plus CND.

Methods

In this study, 29 consecutive patients underwent endoscopic HT with ipsilateral CND via a unilateral axillo-breast approach (endo group), and 30 matched control patients underwent conventional open HT with ipsilateral CND (open group). The following variables were compared between these two groups: perioperative complications, surgery-related outcomes, and pathologic outcomes.

Results

The operating time in the endo group was longer than in the open group (p = 0.012). In terms of parathyroid gland (PTG) preservation, there were no statistically significant differences between the two groups. The mean numbers of dissected central lymph nodes and metastatic central lymph nodes were similar in the two groups (p = 0.506 vs. 0.975). The endo group had a significantly longer mean hospital stay (6.21 ± 0.94 days) than the open group (4.30 ± 1.02 days; p = 0.000). No significant difference was observed in the overall perioperative complications between the two groups.

Conclusions

This study demonstrates that the endoscopic approach of CND plus HT is feasible for selected unilateral, intrathyroidal, micropapillary carcinomas. In the future, prospective and comparative studies on the surgical techniques of total thyroidectomy and CND are needed to verify their oncologic safety.

Keywords

Central neck dissection Cosmetic Endoscopic Gasless Papillary carcinoma Perioperative complications Thyroidectomy 

References

  1. 1.
    Huscher CS, Chiodini S, Napolitano C, Recher A (1997) Endoscopic right thyroid lobectomy. Surg Endosc 11:877CrossRefPubMedGoogle Scholar
  2. 2.
    Yamashita H, Watanabe S, Koike E, Ohshima A, Uchino S, Kuroki S, Tanaka M, Noguchi S (2002) Video-assisted thyroid lobectomy through a small wound in the submandibular area. Am J Surg 183:286–289CrossRefPubMedGoogle Scholar
  3. 3.
    Shimizu K, Akira S, Jasmi AY, Kitamura Y, Kitagawa W, Akasu H, Tanaka S (1999) Video-assisted neck surgery: endoscopic resection of thyroid tumors with a very minimal neck wound. J Am Coll Surg 188:697–703CrossRefPubMedGoogle Scholar
  4. 4.
    Park YL, Han WK, Bae WG (2003) 100 cases of endoscopic thyroidectomy: breast approach. Surg Laparosc Endosc Percutan Tech 13:20–25CrossRefPubMedGoogle Scholar
  5. 5.
    Ohgami M, Ishii S, Arisawa Y, Ohmori T, Noga K, Furukawa T, Kitajima M (2000) Scarless endoscopic thyroidectomy: breast approach for better cosmesis. Surg Laparosc Endosc Percutan Tech 10:1–4PubMedGoogle Scholar
  6. 6.
    Jung EJ, Park ST, Ha WS, Choi SK, Hong SC, Lee YJ, Jeong CY, Joo YT, Moon HG (2007) Endoscopic thyroidectomy using a gasless axillary approach. J Laparoendosc Adv Surg Tech A 17:21–25CrossRefPubMedGoogle Scholar
  7. 7.
    Ikeda Y, Takami H, Sasaki Y, Takayama J, Niimi M, Kan S (2002) Comparative study of thyroidectomies: endoscopic surgery versus conventional open surgery. Surg Endosc 16:1741–1745 [Epub 29 July 2002]CrossRefPubMedGoogle Scholar
  8. 8.
    Kim JS, Kim KH, Ahn CH, Jeon HM, Kim EG, Jeon CS (2001) A clinical analysis of gasless endoscopic thyroidectomy. Surg Laparosc Endosc Percutan Tech 11:268–272CrossRefPubMedGoogle Scholar
  9. 9.
    Shimazu K, Shiba E, Tamaki Y, Takiguchi S, Taniguchi E, Ohashi S, Noguchi S (2003) Endoscopic thyroid surgery through the axillo-bilateral-breast approach. Surg Laparosc Endosc Percutan Tech 13:196–201CrossRefPubMedGoogle Scholar
  10. 10.
    Yeh TS, Jan YY, Hsu BR, Chen KW, Chen MF (2000) Video-assisted endoscopic thyroidectomy. Am J Surg 180:82–85CrossRefPubMedGoogle Scholar
  11. 11.
    Yoon JH, Park CH, Chung WY (2006) Gasless endoscopic thyroidectomy via an axillary approach: experience of 30 cases. Surg Laparosc Endosc Percutan Tech 16:226–231CrossRefPubMedGoogle Scholar
  12. 12.
    Chung YS, Choe JH, Kang KH, Kim SW, Chung KW, Park KS, Han W, Noh DY, Oh SK, Youn YK (2007) Endoscopic thyroidectomy for thyroid malignancies: comparison with conventional open thyroidectomy. World J Surg [Epub ahead of print 14 June]Google Scholar
  13. 13.
    Choe JH, Kim SW, Chung KW, Park KS, Han W, Noh DY, Oh SK, Youn YK (2007) Endoscopic thyroidectomy using a new bilateral axillo-breast approach. World J Surg 31:601–606CrossRefPubMedGoogle Scholar
  14. 14.
    Bellantone R, Lombardi CP, Bossola M, Boscherini M, De Crea C, Alesina PF, Traini E (2002) Video-assisted vs conventional thyroid lobectomy: a randomized trial. Arch Surg 137:301–304 (discussion 305)CrossRefPubMedGoogle Scholar
  15. 15.
    Ikeda Y, Takami H, Sasaki Y, Takayama J, Kan S, Niimi M (2002) Minimally invasive video-assisted thyroidectomy and lymphadenectomy for micropapillary carcinoma of the thyroid. J Surg Oncol 80:218–221CrossRefPubMedGoogle Scholar
  16. 16.
    Kitagawa W, Shimizu K, Akasu H, Tanaka S (2003) Endoscopic neck surgery with lymph node dissection for papillary carcinoma of the thyroid using a totally gasless anterior neck skin-lifting method. J Am Coll Surg 196:990–994CrossRefPubMedGoogle Scholar
  17. 17.
    Shimizu K, Kitagawa W, Akasu H, Tanaka S (2001) Endoscopic hemithyroidectomy and prophylactic lymph node dissection for micropapillary carcinoma of the thyroid by using a totally gasless anterior neck skin lifting method. J Surg Oncol 77:217–220CrossRefPubMedGoogle Scholar
  18. 18.
    Colonna M, Guizard AV, Schvartz C, Velten M, Raverdy N, Molinie F, Delafosse P, Franc B, Grosclaude P (2007) A time trend analysis of papillary and follicular cancers as a function of tumour size: a study of data from six cancer registries in France (1983–2000). Eur J Cancer 43:891–900 [Epub 7 Feb 2007]CrossRefPubMedGoogle Scholar
  19. 19.
    White ML, Gauger PG, Doherty GM (2007) Central lymph node dissection in differentiated thyroid cancer. World J Surg 31:895–904CrossRefPubMedGoogle Scholar
  20. 20.
    Shindo M, Wu JC, Park EE, Tanzella F (2006) The importance of central compartment elective lymph node excision in the staging and treatment of papillary thyroid cancer. Arch Otolaryngol Head Neck Surg 132:650–654CrossRefPubMedGoogle Scholar
  21. 21.
    Koh YW, Kim JW, Lee SW, Choi EC (2008) Endoscopic thyroidectomy via a unilateral axillo-breast approach without gas insufflation for unilateral benign thyroid lesions. Surg Endosc [Epub ahead of print 5 June]Google Scholar
  22. 22.
    Chow SM, Law SC, Chan JK, Au SK, Yau S, Lau WH (2003) Papillary microcarcinoma of the thyroid: prognostic significance of lymph node metastasis and multifocality. Cancer 98:31–40CrossRefPubMedGoogle Scholar
  23. 23.
    Gottlieb A, Sprung J, Zheng XM, Gagner M (1997) Massive subcutaneous emphysema and severe hypercarbia in a patient during endoscopic transcervical parathyroidectomy using carbon dioxide insufflation. Anesth Analg 84:1154–1156CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2009

Authors and Affiliations

  • Yoon Woo Koh
    • 1
  • Jae Hong Park
    • 1
  • Jae Wook Kim
    • 2
  • Seung Won Lee
    • 1
  • Eun Chang Choi
    • 2
  1. 1.Department of Otolaryngology–Head and Neck SurgerySoonchunhyang University College of MedicineBucheonKorea
  2. 2.Department of OtorhinolaryngologyYonsei University College of MedicineSeoulKorea

Personalised recommendations