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KMID : 0371320020620040303
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Journal of the Korean Surgical Society
2002 Volume.62 No. 4 p.303 ~ p.307
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A Clinical Analysis of One Hundred Cases of Endoscopic Thyroidectomy: BreastApproach
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Nam Sang-Yong
Park Yong-Lai
Bae Won-Gil
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Abstract
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Purpose: Neck surgery is one of the newest fields of endoscopic
surgical application. We have developed a technique for performing
endoscopic thyroidectomy using a breast approach and low-pressure
CO2. We report this surgical procedure and its results.
Methods: One hundred patients underwent endoscopic thyroidectomy
using a breast approach. Preoperative fine needle aspiration cytology
revealed 74 benign nodules, 21 follicular neoplasms, 4 in which there was
difficulty in distinguishing between benign and malignant tumor and 1 not
checked. We used 3 incisions on both upper circumareolar areas and one at
about 3 ㎝ below the clavicle on the tumor side. Three trocars, 5 ㎜, 10 ㎜,
15 ㎜ were used. Subplatysmal and subcutaneous operative space was created
with CO2 insufflation at 6 ㎜Hg of pressure. The thyroidal
vessels and the parenchyme of the gland were dissected and divided with an
ultrasonically activated scalpel and commonly used laparoscopic instruments.
Results: The subjects were 93 women and 7 men with ages ranging from
7 to 63 years (mean 38.9 yerars). The operation time 136±9.85 minutes
before year 2000 and 66.8±8.26 at year 2000. There were 6 cases of
conversion to conventional thyroidectomy, 1 case of uncontrolled
intraoperative bleeding, 1 case of invasive follicular carcinoma and 4
papillary carcinoma. Postoperative complications occurred in 5 cases; 1 case
of permanent recurrent laryngeal nerve palsy, 3 cases of transient voice
change and 1 case of severe chest discomfort for 3 months. There was no
occurrence of subcutaneous emphysema. The average of postoperative
hospitalization time was 4.5±0.35 days. Operative scars were completley
concealed by clothes and the patients were satisfied with the cosmetic
result. Conclusion: This approach completely avoided operative scars
in the neck and resulted in satisfactory cosmetic result with minimal scars
in the breast. We believe that endoscopic thyroidectomy using breast
approach is feasible and safe for resection of thyroid tumors.
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