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KMID : 0978820020050020175
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Journal of the Korean Society of Endoscopic & Laparoscopic Surgeons
2002 Volume.5 No. 2 p.175 ~ p.180
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Supraclavicular Endoscopic Thyroidectomy - Early Experience
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Abstract
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Purpose: Conventional thyroidectomy leaves a large scar on the anterior neck. Minimal invasive surgery is popular and it´ often applied to thyroid surgery recently. So many kinds of minimally invasive surgery of thyroid was reported, but there was rare reports of endoscopic thyroidectmy by supraclavicular approach. This study assessed the feasibility of endoscopic thyroidectomy by supraclavicular approach.
Methods: 5 mm and 3 mm skin incisions was made in the sternal notch and in the lower, upper and middle portion of neck along to the anterior border of sternocleidomastoid muscle (SCM) respectively. A 5 m 0°or 30°videoscope and 5 mm and 3 mm instruments was used. After blunt and sharp dissection of subplatysmal plane with subcutaneous tunneler and scissors, the space between SCM and strap muscles was developed. After full dissection, overlying skin retracted upwardly via two 1~0 nylon sutures. CO2 gas was insufflated with 8mmHg initially then to 4 mmHg after skin tenting. Strap muscle was only retracted medially via 3mm port and rarely divided. Thyroid vessels and parenchyma were dissected and divided by ultrasonic shears.
Results: Endoscopic thyroidectomy by supraclavicular approach was successfully done without conversion to open method in all of 42 patients with adenomatous goiter (17) and follicular adenomas (23) micropapillary carcinoma (2). Tumor size was median 2.9 cm (range: 0.5~5 cm). Median operative time was 209 min (range 310~120 min), operative blood loss was mean 67 cc (300~10). Cosmetic result was excellent in all cases. There was no definitive postoperative complications except for 2 cases of transient hoarseness and one case of transient hypocalcemia.
Conclusion: We could successfully perform endoscopic thyroidectomy by supraclavicular approach with good cosmetic results and without significant complications. Endoscopic thyroidectomy by supraclavicular approach can be a good alternative modality of surgery of benign thyroid tumors.
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