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Increasing the Size Limit of Benign Thyroid Lesions Resectable by Endoscopic Thyroidectomy via a Unilateral Axillo-breast Approach Without Gas Insufflation

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Abstract

Background

Endoscopic thyroidectomy is rarely attempted in patients with large goitrous lesions. We examined the feasibility and safety of endoscopic thyroidectomy via a unilateral axillo-breast approach without gas insufflation for resection of large thyroid tumors (≥4 cm).

Methods

The study included 111 patients: 82 in group 1 (tumor diameter <4 cm) and 29 in group 2 (≥ 4 cm). Ninety-one patients underwent hemithyroidectomy and 20 underwent total thyroidectomy. Local complications, surgical outcomes, and pathological outcomes were compared between groups.

Results

Postoperative permanent pathology revealed 24 follicular adenomas and 87 nodular hyperplasias. The mean tumor size in group 2 was 51.10 ± 7.66 mm compared to 25.24 ± 8.14 mm in group 1. The mean volume of the thyroid gland in group 2 was 15.60 ± 3.45 cm3 compared to 11.27 ± 2.40 cm3 in group 1 (p = 0.000). Mean operating time did not differ significantly between groups (p = 0.520). Postoperatively, minor hematomas were encountered in three patients (3.7%) in group 1. Three patients in group 1 (3.7%) and two in group 2 (6.9%) developed transient unilateral vocal cord palsy (p = 0.604). Temporary hypocalcemia was observed in six and one patients in groups 1 and 2, respectively (p = 1.000). No permanent recurrent laryngeal nerve palsy or hypoparathyroidism occurred in either group.

Conclusion

Our data support the safety and feasibility of endoscopic thyroidectomy via a unilateral axillo-breast approach without gas insufflation, even for the treatment of benign thyroid lesions ≥4 cm.

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Disclosure

The authors declare that they have no significant financial interest in or affiliation with the manufacturers of products or devices that are discussed in this article.

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Authors and Affiliations

  1. Department of Otorhinolaryngology, Yonsei University College of Medicine, 134 Shinchon-dong, Seodaemun-gu, Seoul, 120-752, Korea

    Won Shik Kim, Hyun Jun Hong, Yoo Seob Shin, Eun Chang Choi, Hong-Shik Choi & Yoon Woo Koh

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  1. Won Shik Kim
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  2. Hyun Jun Hong
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  3. Yoo Seob Shin
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  4. Eun Chang Choi
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  5. Hong-Shik Choi
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  6. Yoon Woo Koh
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Corresponding author

Correspondence to Yoon Woo Koh.

Additional information

Won Shik Kim and Hyun Jun Hong have contributed equally to this work as co-first authors.

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Kim, W.S., Hong, H.J., Shin, Y.S. et al. Increasing the Size Limit of Benign Thyroid Lesions Resectable by Endoscopic Thyroidectomy via a Unilateral Axillo-breast Approach Without Gas Insufflation. World J Surg 35, 2203–2211 (2011). https://doi.org/10.1007/s00268-011-1232-2

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  • DOI: https://doi.org/10.1007/s00268-011-1232-2

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