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