Abstract
Background
Endoscopic techniques have recently been applied to thyroid surgery. We developed the bilateral axillo-breast (BAB) approach for total thyroidectomy. The aims of this study were to evaluate the completeness of this approach for total thyroidectomy and to compare complications between endoscopic thyroidectomy and conventional open thyroidectomy.
Methods
We analyzed 198 patients who underwent open thyroidectomy and 103 patients who underwent endoscopic thyroidectomy for papillary thyroid microcarcinoma between January 2003 and June 2006 at Seoul National University Hospital. The postoperative thyroglobulin (TG) level was used to assess the completeness of the two methods. Complications such as hypocalcemia or vocal cord palsy were also evaluated.
Results
The mean hospitalization period was 3.18 days following open thyroidectomy and 3.04 days after endoscopic thyroidectomy. The 3-month postoperative TG levels were <1.0 ng/ml in 90.4% of patients after open total thyroidectomy and in 88.9% following endoscopic total thyroidectomy. Transient hypocalcemia occurred in 17.7% and 25.2% of patients, respectively. Permanent hypocalcemia occurred in 4.5% and 1.0% of patients, respectively. Permanent vocal cord palsy frequencies were 0.5% and 0%, respectively. There were no significant differences in postoperative TG levels, hypocalcemia, or permanent vocal cord palsy. Transient vocal cord palsy occurred in 2.5% of patients after open thyroidectomy and in 25.2% after endoscopic thyroidectomy (p < 0.0001), but it disappeared within 3 months. Cosmetic results were excellent after endoscopic thyroidectomy.
Conclusions
The bilateral axillo-breast (BAB) approach for endoscopic thyroidectomy shows insignificant postoperative complications, except transient vocal cord palsy, as well as good cosmetic results. It is also a feasible method for total thyroidectomy. Therefore, the BAB approach for endoscopic total thyroidectomy can be the surgical treatment of choice for selected cases of thyroid cancer.
Similar content being viewed by others
References
Gagner M (1996) Endoscopic subtotal parathyroidectomy in patients with primary hyperparathyroidism. Br J Surg 83:875
Huscher CS, Chiodini S, Napolitano C, et al. (1997) Endoscopic right thyroid lobectomy. Surg Endosc 11:877
Ohgami M, Ishii S, Arisawa Y, et al. (2000) Scarless endoscopic thyroidectomy: breast approach for better cosmesis. Surg Laparosc Endosc 10:1–4
Ikeda Y, Takami H, Niimi M, et al. (2001) Endoscopic thyroidectomy by the axillary approach. Surg Endosc 15:1362–1364
Kitano H, Fujimura M, Kinoshita H, et al. (2002) Endoscopic thyroid resection using cutaneous elevation in lieu of insufflation. Surg Endosc 16:88–91
Shimazu K, Shiba E, Tamaki Y, et al. (2003) Endoscopic thyroid surgery through the axillo-bilateral breast approach. Surg Laparosc Endosc 13:196–201
Duh QY (2003) Presidential address: minimally invasive endocrine surgery—standard of treatment or hype? Surgery 134:849–857
Miccoli P, Elisei R, Materazzi G, et al. (2002) Minimally invasive video-assisted thyroidectomy for papillary carcinoma: a prospective study of its completeness. Surgery 132:1070–1074
Yamamoto M, Sasaki A, Asahi H, et al. (2001) Endoscopic subtotal thyroidectomy for patients with Graves’ disease. Surg Today 31:1–4
Ikeda Y, Takami Y, Sasaki J, et al. (2002) Compartive study of thyroidectomies: endoscopic surgery vs conventional open surgery. Surg Endosc 16:1741–1745
Takami H, Ikeda Y (2002) Minimally invasive thyroidectomy. ANZ J Surg 72:841–842
Ikeda Y, Takami H, Sasaki Y, et al. (2002) Minimally invasive video-assisted thyroidectomy and lymphadenectomy for micropapillary carcinoma of the thyroid. J Surg Oncol 80:218–221
Miccoli P, Berti P, Raffaelli M, et al. (2001) Comparison between minimally invasive video-assisted thyroidectomy and conventional thyroidectomy: a prospective randomized study. Surgery 130:1039–1043
Randolph GW (2003) Surgery of the Thyroid and Parathyroid Glands. Philadelphia, Saunders, pp. 434–439
Yamamoto M, Sasaki A, Asahi H, et al. (2002) Endoscopic versus conventional open thyroid lobectomy for benign thyroid nodules. Surg Laparosc Endosc 12:426–429
Park YL, Han WK, Bae WK (2003) 100 Cases of endoscopic thyroidectomy. Surg Laparosc Endosc 13:20–25
Bergamaschi R, Becouarn G, Ronceray J, et al. (1998) Morbidity of thyroid surgery. Am J Surg 176:71–75
Harness JK, Fung L, Thompson NW, et al. (1986) Total thyroidectomy: complications and technique. World J Surg 10:781–785
Moulton-Barrett R, Crumley R, Jalilie S, et al. (1997) Complications of thyroid surgery. Int Surg 82:63–66
Herranz-Gonzalez J, Gavilan J, Mainez-Vidal J, et al. (1991) Complications following thyroid surgery. Arch Otolaryngol Head Neck Surg 117:516–518
de Roy van Zuidewijn DB, Songun I, Kievit J, et al. (1995) Complications of thyroid surgery. Ann Surg Oncol 2:56–60
Filho JG, Kowalski LP (2004) Postoperative complications of thyroidectomy for differentiated thyroid carcinoma. Am J Otolaryngol 25:225–230
Marchesi M, Biffoni M, Cresti R, et al. (2003) Ultrasonic scalpel in thyroid surgery. Chir Ital 55:299–308
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Chung, Y.S., Choe, JH., Kang, KH. et al. Endoscopic Thyroidectomy for Thyroid Malignancies: Comparison with Conventional Open Thyroidectomy. World J Surg 31, 2302–2306 (2007). https://doi.org/10.1007/s00268-007-9117-0
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00268-007-9117-0