Skip to main content

Advertisement

SpringerLink
Log in

Gasless endoscopic transaxillary thyroid surgery: CUSUM analysis of a single surgeon’s experience from 105 preliminary procedures

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

We aimed to evaluate the feasibility and oncologic safety of gasless endoscopic transaxillary thyroidectomy (TAT) in patients with thyroid diseases. Improvements in surgical techniques were also reported, and the learning curves of gasless endoscopic TAT were further studied.

Methods

An exact 1:1 matching analysis was performed to compare the technical safety and oncologic outcomes between TAT and conventional open surgery. A questionnaire was designed to evaluate the quality of life of enrolled patients. A cumulative summation analysis was designed for the quantitative estimation of the learning curves.

Results

A total of 105 consecutive patients who successfully received endoscopic TAT were retrospectively enrolled in the current study. A standard three-step working space making procedure, an approach that does not free the superficial part of the sternal head of the sternocleidomastoid muscle (SCM, NFSSH) and a “point to line to surface” en bloc procedure utilized in lobectomy with ipsilateral central neck dissection (CND), were introduced in our surgical procedures. The mean operation time in the TAT group was significantly longer than that in the conventional open group (86.9 ± 31.3 vs 44.2 ± 8.3, p < 0.001). Significant differences in the complication rate were not found between the two groups. Discomfort in the anterior neck area and SCM was relieved over time in most cases (verbal response scores (VRSs) were gradually decreased over time). The learning curves for working space making, ipsilateral thyroidectomy and the total endoscopic TAT approach were 45 cases, 25 cases and 42 cases, respectively. The operation time in the proficient group was significantly shorter than that in the learning group (67.0 ± 8.4 vs 112.3 ± 35.7, p < 0.001). VRSs in the SCM were significantly lower in the proficient group (for 1 week: 1.25 ± 0.65 vs 2.40 ± 0.63, p < 0.001; for 1 month: 0.81 ± 0.69 vs 1.81 ± 0.40, p < 0.001).

Conclusions

Gasless endoscopic TAT was safe in a cohort of patients with thyroid diseases, with satisfactory surgical outcomes and cosmetic appearance. The learning curve for endoscopic TAT was approximately 42 cases. The proficiency of the endoscopic TAT approach depended primarily on the proficiency of working space making.

Graphical abstract

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

Access this article

Log in via an institution

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

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Sephton BM (2019) Extracervical approaches to thyroid surgery: evolution and review. Minim Invasive Surg 2019:5961690

    CAS  PubMed  PubMed Central  Google Scholar 

  2. 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 

  3. Bhatia P, Mohamed HE, Kadi A, Kandil E, Walvekar RR (2015) Remote access thyroid surgery. Gland Surg 4:376–387

    PubMed  PubMed Central  Google Scholar 

  4. Russell JO, Sahli ZT, Shaear M, Razavi C, Ali K, Tufano RP (2020) Transoral thyroid and parathyroid surgery via the vestibular approach—a 2020 update. Gland Surg 9:409–416

    Article  PubMed  PubMed Central  Google Scholar 

  5. Yang Y, Gu X, Wang X, Xiang J, Chen Z (2012) Endoscopic thyroidectomy for differentiated thyroid cancer. Sci World J 2012:456807

    Article  Google Scholar 

  6. Anuwong A, Ketwong K, Jitpratoom P, Sasanakietkul T, Duh QY (2018) Safety and outcomes of the transoral endoscopic thyroidectomy vestibular approach. JAMA Surg 153:21–27

    Article  PubMed  Google Scholar 

  7. Jiang WJ, Yan PJ, Zhao CL, Si MB, Tian W, Zhang YJ, Tian HW, Feng SW, Han CW, Yang J, Yang KH, Guo TK (2020) Comparison of total endoscopic thyroidectomy with conventional open thyroidectomy for treatment of papillary thyroid cancer: a systematic review and meta-analysis. Surg Endosc 34:1891–1903

    Article  PubMed  Google Scholar 

  8. Kang SW, Lee SC, Lee SH, Lee KY, Jeong JJ, Lee YS, Nam KH, Chang HS, Chung WY, Park CS (2009) Robotic thyroid surgery using a gasless, transaxillary approach and the da Vinci S system: the operative outcomes of 338 consecutive patients. Surgery 146:1048–1055

    Article  PubMed  Google Scholar 

  9. Piccoli M, Mullineris B, Gozzo D, Colli G, Pecchini F, Nigro C, Rochira V (2019) Evolution strategies in transaxillary robotic thyroidectomy: considerations on the first 449 cases performed. J Laparoendosc Adv Surg Tech A 29:433–440

    Article  PubMed  PubMed Central  Google Scholar 

  10. Haugen BR, Alexander EK, Bible KC, Doherty GM, Mandel SJ, Nikiforov YE, Pacini F, Randolph GW, Sawka AM, Schlumberger M, Schuff KG, Sherman SI, Sosa JA, Steward DL, Tuttle RM, Wartofsky L (2016) 2015 American Thyroid Association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: the American Thyroid Association guidelines task force on thyroid nodules and differentiated thyroid cancer. Thyroid 26:1–133

    Article  PubMed  PubMed Central  Google Scholar 

  11. Liang J, Zhan L, Xuan M, Zhao Q, Chen L, Yan J, Kuang J, Tan J, Qiu W (2021) Thyroidectomy for thyroid cancer via transareola single-site endoscopic approach: results of a case-match study with large-scale population. Surg Endosc. https://doi.org/10.1007/s00464-021-08424-y

    Article  PubMed  Google Scholar 

  12. Johri G, Chand G, Mishra A, Mayilvaganan S, Agarwal G, Agarwal A, Mishra SK (2020) Endoscopic versus conventional thyroid surgery: a comparison of quality of life, cosmetic outcomes and overall patient satisfaction with treatment. World J Surg 44:4118–4126

    Article  PubMed  Google Scholar 

  13. Kim MJ, Lee J, Lee SG, Choi JB, Kim TH, Ban EJ, Lee CR, Kang SW, Jeong JJ, Nam KH, Jo YS, Chung WY (2017) Transaxillary robotic modified radical neck dissection: a 5-year assessment of operative and oncologic outcomes. Surg Endosc 31:1599–1606

    Article  PubMed  Google Scholar 

  14. Kim H, Kwon H, Lim W, Moon BI, Paik NS (2019) Quantitative assessment of the learning curve for robotic thyroid surgery. J Clin Med. https://doi.org/10.3390/jcm8030402

    Article  PubMed  PubMed Central  Google Scholar 

  15. Chai YJ, Chae S, Oh MY, Kwon H, Park WS (2021) Transoral endoscopic thyroidectomy vestibular approach (TOETVA): surgical outcomes and learning curve. J Clin Med. https://doi.org/10.3390/jcm10040863

    Article  PubMed  PubMed Central  Google Scholar 

  16. Kandil E, Akkera M, Shalaby H, Munshi R, Attia A, Elnahla A, Shalaby M, Abdelgawad M, Grace L, Kang SW (2021) A single surgeon’s 10-year experience in remote-access thyroid and parathyroid surgery. Am Surg 87:638–644

    Article  PubMed  Google Scholar 

  17. Kim EY, Lee KH, Park YL, Park CH, Lee CR, Jeong JJ, Nam KH, Chung WY, Yun JS (2017) Single-incision, gasless, endoscopic trans-axillary total thyroidectomy: a feasible and oncologic safe surgery in patients with papillary thyroid carcinoma. J Laparoendosc Adv Surg Tech A 27:1158–1164

    Article  PubMed  Google Scholar 

  18. Kim JK, Lee CR, Kang SW, Jeong JJ, Nam KH, Chung WY (2021) Robotic transaxillary lateral neck dissection for thyroid cancer: learning experience from 500 cases. Surg Endosc. https://doi.org/10.1007/s00464-021-08526-7

    Article  PubMed  PubMed Central  Google Scholar 

  19. Khan ZA, Mehta S, Sumathi N, Dhiwakar M (2018) Occult invasion of sternothyroid muscle by differentiated thyroid cancer. Eur Arch Otorhinolaryngol 275:233–238

    Article  PubMed  Google Scholar 

  20. Rotolo N, Cattoni M, Imperatori A (2017) Complications from tracheal resection for thyroid carcinoma. Gland Surg 6:574–578

    Article  PubMed  PubMed Central  Google Scholar 

  21. Zhou Y, Cai Y, Sun R, Shui C, Ning Y, Jiang J, Wang W, Sheng J, Jiang Z, Tang Z, Tian W, Zheng C, Ge M, Li C (2021) Gasless transaxillary endoscopic thyroidectomy for unilateral low-risk thyroid cancer: Li’s six-step method. Gland Surg 10:1756–1766

    Article  PubMed  PubMed Central  Google Scholar 

  22. Cao F, Jin K, Cui B, Xie B (2013) Learning curve for endoscopic thyroidectomy: a single teaching hospital study. OncoTargets Ther 6:47–52

    Google Scholar 

  23. Lira RB, Ramos AT, Nogueira RMR, de Carvalho GB, Russell JO, Tufano RP, Kowalski LP (2020) Transoral thyroidectomy (TOETVA): complications, surgical time and learning curve. Oral Oncol 110:104871

    Article  PubMed  Google Scholar 

  24. Lörincz BB, Busch CJ, Möckelmann N, Knecht R (2015) Initial learning curve of single-incision transaxillary robotic hemi- and total thyroidectomy—a single team experience from Europe. Int J Surg 18:118–122

    Article  PubMed  Google Scholar 

Download references

Funding

This work was supported by the National Natural Science Foundation of China (Grant No. 82073262) and the Hunan Province Natural Science Foundation (Grant Number 2021JJ41033).

Author information

Author notes

  1. Botao Sun and Peiting Li have contributed equally to this study.

Authors and Affiliations

  1. Department of General Surgery, Xiangya Hospital, Central South University, No. 87 Xiangya Road, Changsha, 410008, China

    Botao Sun, Peiting Li, Rong Cong, Di Zhou, Zeyu Zhang, Fada Xia & Xinying Li

  2. Department of Plastic Surgery, The Third Xiangya Hospital of Central South University, No. 172 Tong Zi Po Road, Changsha, 410008, China

    Peiting Li

Authors
  1. Botao Sun
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Peiting Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Rong Cong
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Di Zhou
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Zeyu Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Fada Xia
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Xinying Li
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All authors made substantive intellectual contributions to this study to qualify as authors. FDX conceived of the design of the study. XYL modified the design of the study. BTS, PTL, RC, ZYZ performed the study, collected the data, and contributed to the design of the study. XYL, BTS, DZ analyzed the data. BTS, PTL drafted Result, Discussion, Conclusion sections. XYL, FDX drafted Methods sections. FDX, XYL edited the manuscript. All authors read and approved the final manuscript. All authors have agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Corresponding author

Correspondence to Fada Xia.

Ethics declarations

Disclosures

Botao Sun, Peiting Li, Rong Cong, Di Zhou, Zeyu Zhang, Fada Xia and Xinying Li have no conflicts of interest or financial ties to disclose.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (PDF 74 KB)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Sun, B., Li, P., Cong, R. et al. Gasless endoscopic transaxillary thyroid surgery: CUSUM analysis of a single surgeon’s experience from 105 preliminary procedures. Surg Endosc 36, 8270–8279 (2022). https://doi.org/10.1007/s00464-022-09273-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-022-09273-z

Keywords

Search

Navigation