Skip to main content
Log in

“Scarless” (in the Neck) Endoscopic Thyroidectomy (SET): An Evidence-based Review of Published Techniques

  • Published:
World Journal of Surgery Aims and scope Submit manuscript

Abstract

Background

Excision of the thyroid through a skin crease incision in the anterior neck provides good direct exposure to facilitate safe dissection and a quick operation with low morbidity and minimal mortality. However, these patients still have a scar in the neck. Technologic innovations have allowed surgeons to remove the thyroid gland from a remote site, providing a scarless outcome in the neck. This study was designed to assess the different techniques of scarless (in the neck) endoscopic thyroidectomy (SET) by reviewing the current literature.

Methods

A computer-assisted search of the Medline database through September 2007 was undertaken. The combination of terms used included the following: endoscopic thyroidectomy; minimally invasive thyroidectomy; minimally invasive endocrine surgery; thyroidectomy via the axillary approach; thyroidectomy via the anterior approach; and thyroidectomy via the breast approach. Additional data were provided based on previously unpublished experience from our own unit with SET.

Results

There were seven studies that involved 186 patients in whom the thyroid was excised via the axillary method and five published series that involved 169 patients who had thyroidectomies performed via the anterior approach. There were four published series of thyroidectomies performed via a hybrid approach, which is a combination of both the anterior and axillary approach, involving 180 patients. Four studies compared SET and another approach for a thyroidectomy. In our unpublished series of SET, we performed 20 cases during a 2-year period comprising 11 cases via the axillary approach and 9 cases via the anterior/breast approach. Nineteen cases were lobectomies and one case was an isthmusectomy. SET was associated with a longer operative time and increase postoperative pain. Patients who had SET were satisfied with the aesthetic outcome of the procedure.

Conclusion

Scarless (in the neck) endoscopic thyroidectomy is not a minimally invasive technique but a maximally invasive one that involves a longer operative time and greater postoperative pain. What it does provide is a safe excision of the thyroid pathology with the absence of a scar in the neck. However, there is a steep learning curve. With experience and newer surgical instruments, the operative time and postoperative pain might decrease.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Sackett DL (1989) Rules of evidence and clinical recommendations on the use of antithrombotic agents. Chest 95(2 Suppl):2S–4S

    Article  PubMed  CAS  Google Scholar 

  2. Ikeda Y, Takami H, Niimi M, Kan S, Sasaki Y, Takayama J (2002) Endoscopic thyroidectomy and parathyroidectomy by the axillary approach. A preliminary report. Surg Endosc 16:92–95

    Article  PubMed  CAS  Google Scholar 

  3. Udomsawaengsup S, Navicharern P, Tharavej C, Pungpapong SU (2004) Endoscopic transaxillary thyroid lobectomy: flexible vs. rigid laparoscope. J Med Assoc Thai 87(suppl 2):S10–S14

    PubMed  Google Scholar 

  4. Chantawibul S, Lokechareonlarp S, Pokawatana C (2003) Total video endoscopic thyroidectomy by an axillary approach. J Laparoendosc Adv Surg Tech A 13:295–299

    Article  PubMed  Google Scholar 

  5. Yoon JH, Park CH, Chung WY (2006) Gasless endoscopic thyroidectomy via an axillary approach: experience of 30 cases. Surg Laparosc Endosc Percutan Tech 16:226–231

    Article  PubMed  Google Scholar 

  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 17:21–25

    Article  PubMed  Google Scholar 

  7. Witzel K (2007) The axillary access in unilateral thyroid resection. Langenbecks Arch Surg 392:617–621

    Article  PubMed  Google Scholar 

  8. Duncan TD, Rashid Q, Speights F, Ejeh I (2007) Endoscopic transaxillary approach to the thyroid gland: our early experience. Surg Endosc 21:2166–2171

    Article  PubMed  CAS  Google Scholar 

  9. 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 10:1–4

    Article  PubMed  CAS  Google Scholar 

  10. Yamamoto M, Sasaki A, Asahi H, Shimada Y, Sato N, Nakajima J, Mashima R, Saito K (2001) Endoscopic subtotal thyroidectomy for patients with Graves’ disease. Surg Today 31:1–4

    Article  PubMed  CAS  Google Scholar 

  11. Takami H, Ikeda Y (2002) Minimally invasive thyroidectomy. ANZ J Surg 72:841–842

    Article  PubMed  Google Scholar 

  12. Park YL, Han WK, Bae WG (2003) 100 cases of endoscopic thyroidectomy: breast approach. Surg Laparosc Endosc Percutan Tech 13:20–25

    Article  PubMed  Google Scholar 

  13. Cho YU, Park IJ, Choi KH, Kim SJ, Choi SK, Hur YS, Lee KY, Ahn SI, Hong KC, Shin SH, Kim KR, Woo ZH (2007) Gasless endoscopic thyroidectomy via an anterior chest wall approach using a flap-lifting system. Yonsei Med J 48:480–487

    Article  PubMed  Google Scholar 

  14. Kitano H, Fujimura M, Kinoshita T, Kataoka H, Hirano M, Kitajima K (2002) Endoscopic thyroid resection using cutaneous elevation in lieu of insufflation. Surg Endosc 16:88–91

    Article  PubMed  CAS  Google Scholar 

  15. 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 13:196–201

    Article  PubMed  Google Scholar 

  16. Bärlehner E, Benhidjeb T (2007) Cervical scarless endoscopic thyroidectomy: sxillo-bilateral-breast approach (ABBA). Surg Endosc 22:154–157

    Article  PubMed  Google Scholar 

  17. 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 31:601–606

    Article  PubMed  Google Scholar 

  18. Ikeda Y, Takami H, Sasaki Y, Takayama J, Niimi M, Kan S (2003) Clinical benefits in endoscopic thyroidectomy by the axillary approach. J Am Coll Surg 196:189–195

    Article  PubMed  Google Scholar 

  19. 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

    Article  PubMed  CAS  Google Scholar 

  20. Ikeda Y, Takami H, Sasaki Y, Takayama J, Kurihara H (2004) Are there significant benefits of minimally invasive endoscopic thyroidectomy? World J Surg 28:1075–1078

    Article  PubMed  Google Scholar 

  21. 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 31:2302–2308

    Article  PubMed  Google Scholar 

  22. Hüscher CS, Chiodini S, Napolitano C, Recher A (1997) Endoscopic right thyroid lobectomy. Surg Endosc 11:877

    Article  PubMed  Google Scholar 

  23. Gagner M (1996) Endoscopic subtotal parathyroidectomy in patients with primary hyperparathyroidism. Br J Surg 83:875

    Article  PubMed  CAS  Google Scholar 

  24. Palazzo FF, Sebag F, Henry JF (2006) Endocrine surgical technique: endoscopic thyroidectomy via the lateral approach. Surg Endosc 20:339–342

    Article  PubMed  CAS  Google Scholar 

  25. Miccoli P, Bellantone R, Mourad M, Walz M, Raffaelli M, Berti P (2002) Minimally invasive video-assisted thyroidectomy: multiinstitutional experience. World J Surg 26:972–975

    Article  PubMed  Google Scholar 

  26. Ikeda Y, Takami H, Sasaki Y, Kan S, Niimi M (2000) Endoscopic neck surgery by the axillary approach. J Am Coll Surg 191:336–340

    Article  PubMed  CAS  Google Scholar 

  27. Brunt LM, Jones DB, Wu JS, Quasebarth MA, Meininger T, Soper NJ (1997) Experimental development of an endoscopic approach to neck exploration and parathyroidectomy. Surgery 122:893–901

    Article  PubMed  CAS  Google Scholar 

  28. Kitano H, Fujimura M, Hirano M, Sato I, Kataoka H, Kinoshita T, Ogawa T, Masuda S, Kitajima K (2000) Endoscopic surgery for lateral cervical cysts. A report of three cases. Surg Endosc 14:1086

    PubMed  CAS  Google Scholar 

  29. Duh QY (2003) Presidential address: minimally invasive endocrine surgery–standard of treatment or hype? Surgery 134:849–857

    Article  PubMed  Google Scholar 

  30. Owaki T, Nakano S, Arimura K, Aikou T (2002) The ultrasonic coagulating and cutting system injures nerve function. Endoscopy 34:575–579

    Article  PubMed  CAS  Google Scholar 

  31. Ikeda Y, Takami H, Niimi M, Kan S, Sasaki Y, Takayama J (2002) Endoscopic total parathyroidectomy by the anterior chest approach for renal hyperparathyroidism. Surg Endosc 16:320–322

    Article  PubMed  CAS  Google Scholar 

  32. Brunaud L, Zarnegar R, Wada N, Ituarte P, Clark OH, Duh QY (2003) Incision length for standard thyroidectomy and parathyroidectomy: when is it minimally invasive? Arch Surg 138:1140–1143

    Article  PubMed  Google Scholar 

  33. Delbridge L (2006) Solitary thyroid nodule: current management. ANZ J Surg 76:381–386

    Article  PubMed  Google Scholar 

  34. Wong Z, Muthu C, Craik J, Carter J, Harman CR (2004) Role of intraoperative frozen section in the management of thyroid nodules. ANZ J Surg 74:1052–1055

    Article  PubMed  Google Scholar 

  35. Takami HE, Ikeda Y (2006) Minimally invasive thyroidectomy. Curr Opin Oncol 18:43–47

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Charles T. K. Tan.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Tan, C.T.K., Cheah, W.K. & Delbridge, L. “Scarless” (in the Neck) Endoscopic Thyroidectomy (SET): An Evidence-based Review of Published Techniques. World J Surg 32, 1349–1357 (2008). https://doi.org/10.1007/s00268-008-9555-3

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00268-008-9555-3

Keywords

Navigation