Abstract
Background
The aim of the present study was to test the safety and feasibility of the dorsal approach endoscopic thyroidectomy procedure in a prospective trial in humans, after the procedure had been developed ex vivo in human cadavers.
Methods
A total of 28 patients were enrolled for 30 unilateral procedures of thyroidectomy. Two cases were staged bilateral procedures. Patients presenting with suspicious cold nodules, hot nodules, or goiters were operated on under general anaesthesia. Skin incision is carried out on the scalp, behind the ear. Deep to the sternocleidomastoid muscle, but respecting the superficial cervical fascia, the preparation goes past the carotid triangle to reach the thyroid below the straight neck muscles. Postoperatively the patients underwent neurological assessment, vocal cord examination, clinical control for hemorrhage, and determination of serum levels of Ca2+.
Results
Thirty unilateral procedures by the dorsal approach were carried out in 22 women and 6 men. There was 1 subtotal thyroidectomy and 29 total unilateral thyroidectomies with no conversions. There was one permanent recurrent laryngeal nerve (RLN) lesion and one postoperative hemorrhage. The size of the lobes removed ranged from 6 to 40 ml (mean: 18 ml). In four cases the specimen exceeded 38 ml. There was one multifocal papillary cancer requiring open surgical revision and lymphadenectomy. The other diagnoses were benign. All wounds healed by primary intention. Temporary impairment of cervical nerves was detected in six patients. It was possible to avoid access-related problems by improving the patient’s positioning on the operating table, omitting straight instruments, and respecting the superficial fascia before entering the carotid triangle.
Conclusions
Hemithyroidectomy by the dorsal approach is feasible. It is a single surgeon, single port, gasless unilateral endoscopic technique with the option to go bilateral.
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References
Dralle H (2009) Chirurgische Arbeitsgemeinschaft Endokrinologie (CAEK) der deutschen Gesellschaft für Allgemein- und Visceralchirurgie (DGAV) und für die Deutsche Gesellschaft für Chirurgie (DGCH). [Identification oft the recurrent laryngeal nerve and parathyroids in thyroid surgery]. Chirurg 80:352–363
Röher HD, Goretzki PE, Hellmann P et al (1999) Complications in thyroid surgery. Incidence and therapy. Chirurg 70:999–1010
Miccoli M, Bellantone R, Mourad M et al (2002) Minimal invasive video-assisted thyroidectomy: multiinstitutional experience. World J Surg 26:972–975
Ikeda Y, Takami M, Niimi M et al (2001) Endoscopic thyroidectomy by the axillary approach. Surg Endosc 15:1362–1364
Henry JF, Sebag F (2006) Lateral endoscopic approach for thyroid and parathyroid surgery. Ann Chir 131:51–56
Shimazu K, Shiba E, Tamaki Y et al (2003) Endoscopic thyroid surgery through the axillo-bilateral-breast approach. Surg Laparosc Endosc Percutan Tech 13:196–201
Ishii S, Ohgami M, Arisawa Y (1998) Endoscopic thyroidectomy with the anterior chest wall approach. Surg Endosc 12:611
Park YL, Han WK, Bae WG (2003) 100 cases of endoscopic thyroidectomy: breast approach. Surg Laparosc Endosc Percutan Tech 13:20–25
Schardey HM, Schopf S, Kammal M et al (2008) Invisible scar endoscopic thyroidectomy by the dorsal approach: experimental development of a new technique with human cadavers and preliminary clinical results. Surg Endosc 22:813–820
Kim FJ, Chammas MF Jr, Gewehr E et al (2008) Temperature safety profile of laparoscopic devices: Harmonic Ace (ACE), Ligasure V (LV), and plasma trisector (PT). Surg Endosc 22:1464–1469
Strik MW, Anders S, Barth M et al (2007) Total videoendoscopic thyroid resection by the axillobilateral breast approach. Operative method and first results. Chirurg 78:1139–1144
Fiolka A, Can S, Schneider A et al (2008) Instrumentation and surgical technique for an innovative safe sigmoid approach for NOTES. Minim Invasive Ther Allied Technol 17:336–340
Lee KE, Kim HY, Park WS et al (2009) Postauricular and axillary approach endoscopic neck surgery: a new technique. World J Surg 33:767–772
Choe JH, Kim SW, Chung KW et al (2007) Endoscopic thyroidectomy using a new bilateral axillo-breast approach. World J Surg 31:601–606
Lamadé W, Ulmer C, Seimer A et al (2007) A new system for continuous recurrent laryngeal nerve monitoring. Minim Invasive Ther Allied Technol 16:149–154
Gemsenjäger E (2005) Atlas der Schilddrüsenchirurgie. Hans Huber Verlag, Bern, Switzerland
Ikeda Y, Takami H, Sasaki Y et al (2004) Are there significant benefits of minimally invasive endoscopic thyroidectomy? World J Surg 28:1075–1078
Benhidjeb T, Wilhelm T, Harlaar J et al (2009) Natural orifice surgery on thyroid gland: totally transoral video-assisted thyroidectomy (TOVAT): report of first experimental results of a new surgical method. Surg Endosc 23:1119–1120
Acknowledgments
We thank Karl-Storz GmbH CO.KG, Tuttlingen, Germany as well as Ethicon Endo-Surgery and The European Surgical Institute, Hamburg, Germany, for supporting our work by covering the costs of patient insurance, fees for the ethical committee, and logistics. Karl-Storz GmbH CO.KG, Tuttlingen, Germany, in addition, supplied the spatula for retraction and camera work in various versions.
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Schardey, H.M., Barone, M., Pörtl, S. et al. Invisible Scar Endoscopic Dorsal Approach Thyroidectomy: A Clinical Feasibility Study. World J Surg 34, 2997–3006 (2010). https://doi.org/10.1007/s00268-010-0769-9
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DOI: https://doi.org/10.1007/s00268-010-0769-9