Surgical Endoscopy

, Volume 24, Issue 11, pp 2895–2899 | Cite as

Retro-auricular video-assisted “gasless” thyroidectomy: feasibility study in human cadavers

  • Rohan R. WalvekarEmail author
  • Eric Wallace
  • Beau Bergeron
  • Richard Whitworth
  • D. David Beahm
  • Daniel W. Nuss
Dynamic Manuscript



In recent years, there has been a surge of interest in developing alternative surgical approaches to the thyroid gland with a focus on cosmesis. Approaches can be either complete endoscopic approaches using CO2 insufflation or endoscopy-assisted approaches. We describe a novel approach for thyroidectomy via a retro-auricular incision without gas insufflation using endoscopic assistance.


Six fresh human cadavers were utilized. Four head and neck specimens were used to assess the retro-auricular approach and the creation of surgical space in the lower neck. Three hemithyroidectomy in two fresh human cadavers procedures were performed via a retro-auricular approach. The end-point of the study was successful removal of the hemithyroid gland with preservation of the recurrent laryngeal nerve.


In all cases, the retro-auricular flap and subplatysmal plane could be achieved without difficulty. Three hemithyroid specimens were successfully removed in two cadaveric specimens using the retro-auricular approach with endoscopic guidance. Thyroid gland resection with identification and preservation of the recurrent laryngeal nerve could be achieved in all three procedures (100%).


The retro-auricular approach or the “Walvekar approach” permits adequate working space and an excellent endoscopic surgical view for removal of the ipsilateral hemithyroid gland with an option for a bilateral approach using a “gasless technique.”


Retro-auricular approach Video-assisted thyroidectomy Minimally invasive Distant access Novel techniques 



The authors would like to thank Anthony Wells and Reginauld Delmore, Department of Anatomy, Louisiana State University School of Public Health, Trey Joseph (Stryker Endoscopy), Sera Pena, BSc and Celeste Gary BSc, LSU School of Medicine for their help in setting up the cadaveric dissections. The authors would also acknowledge Peter Oliver, PhD, Department of Cell Biology and Anatomy, for his contribution to editing the video presented in this paper. We also would like to acknowledge D. David Beahm, MD, in addition to his contributions to the paper, for narrating this video.


Authors Rohan R Walvekar, Eric Wallace, Beau Bergeron, Richard Whitworth, D. David Beahm, and Daniel W Nuss have no conflicts of interest or financial ties to disclose.

Supplementary material

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  1. 1.
    Yeung GH (2002) Endoscopic thyroid surgery today: a diversity of surgical strategies. Thyroid 12:703–706CrossRefPubMedGoogle Scholar
  2. 2.
    Schardey HM, Schopf S, Kammal M, Barone M, Rudert W, Herandez-Richter T, Portl S (2008) Invisible scar endoscopic thyroidectomy by the dorsal approach: experimental development of a new technique with human cadavers and preliminary clinical results. Surg Endosc 22:813–820CrossRefPubMedGoogle Scholar
  3. 3.
    Duncan TD, Rashid Q, Speights F, Ejeh I (2007) Endoscopic transaxillary approach to the thyroid gland: our early experience. Surg Endosc 21:2166–2171CrossRefPubMedGoogle Scholar
  4. 4.
    Roh JL (2005) Retroauricular hairline incision for removal of upper neck masses. Laryngoscope 115:2161–2166CrossRefPubMedGoogle Scholar
  5. 5.
    Roh JL (2006) Removal of the submandibular gland by a retroauricular approach. Arch Otolaryngol Head Neck Surg 132:783–787CrossRefPubMedGoogle Scholar
  6. 6.
    Terris DJ, Gourin CG, Chin E (2006) Minimally invasive thyroidectomy: basic and advanced techniques. Laryngoscope 116:350–356CrossRefPubMedGoogle Scholar
  7. 7.
    Tan CT, Cheah WK, Delbridge L (2008) “Scarless” (in the neck) endoscopic thyroidectomy (SET): an evidence-based review of published techniques. World J Surg 32:1349–1357CrossRefPubMedGoogle Scholar
  8. 8.
    Kang SW, Jeong JJ, Nam KH, Chang HS, Chung WY, Park CS (2009) Robot-assisted endoscopic thyroidectomy for thyroid malignancies using a gasless transaxillary approach. J Am Coll Surg 209:e1–e7CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  • Rohan R. Walvekar
    • 1
    Email author
  • Eric Wallace
    • 1
  • Beau Bergeron
    • 1
  • Richard Whitworth
    • 2
  • D. David Beahm
    • 1
  • Daniel W. Nuss
    • 1
  1. 1.Department of Otolaryngology Head and Neck SurgeryLSU Health Sciences CenterNew OrleansUSA
  2. 2.Departments of Anatomy and Cell BiologyLSU Health Sciences CenterNew OrleansUSA

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