양성 갑상선결절에서의 일측 액와-유방접근법을 이용한 무기하 내시경 반갑상선절제술：새로운 접근법에 대한 예비결과
Endoscopic Hemithyroidectomy via a Unilateral Axillo-Breast Approach without Gas Insufflation in Unilateral Benign Thyroid Lesions：Preliminary Results of a Novel Approach
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Although the usefulness of various endoscopic thyroid surgery techniques has been reviewed, little specific information is available regarding ENT surgeons who maybe unfamiliar with laparoscopic surgery and must performing endoscopic thyroidectomy. We examined the feasibility and safety of endoscopic thyroid surgery via a novel approach without gas insufflation. Subjects and Method：Forty-one patients undergoing endoscopic hemithyroidectomy via a unilateral axillo-breast approach without gas insufflation were enrolled in this study. Our indications for endoscopic thyroid surgery were as follows：1) benign nodules less than 6 cm in diameter, 2) follicular neoplasm less than 6 cm in diameter, and 3) only unilateral thyroid lesions. The following variables were examined：perioperative complications, operation time, diameter of resected thyroid nodule, permanent pathology, time of hospital discharge after operation, duration of drain placement, and total amount of drainage. Results：Postoperative pathology revealed 8 follicular adenomas, 31 nodular hyperplasias, and 2 lymphocytic thyroiditis. The operating time in the first 10 hemithyroidectomies was 154.0±64.88 min, which was 38.07 min longer than in the last 31 hemithyroidectomies (115.93±32.64 min；p=0.1426). The amount and duration of postoperative drainage were 249.34± 118.47 mL in 4.01±1.31 days, respectively. The postoperative hospital stay was 6.12±1.99 days. Overall, perioperative complications occurred in seven patients (7/41, 17.1%), including one transient recurrent laryngeal nerve palsies (2.4%), five seromas (12.2%), and one hematoma (2.4%), which arose from a subplatysmal skin flap. Conclusion：These results suggest that endoscopic hemithyroidectomy via a unilateral axillo-breast approach without gas insufflation is safe and effective in selective unilateral benign thyroid lesions and appears to provide better cosmetic results and a shorter operation time than other endoscopic thyroidectomy methods. However, more invasiveness due to significant dissection aimed at obtaining an adequate working space and longer operation time needed than with either traditional open surgery or the minimally invasive video assisted technique should be overcome through accumulation of experience. (Korean J Otorhinolaryngol-Head Neck Surg 2008;51:805-11)
Abstract
Although the usefulness of various endoscopic thyroid surgery techniques has been reviewed, little specific information is available regarding ENT surgeons who maybe unfamiliar with laparoscopic surgery and must performing endoscopic thyroidectomy. We examined the feasibility and safety of endoscopic thyroid surgery via a novel approach without gas insufflation. Subjects and Method：Forty-one patients undergoing endoscopic hemithyroidectomy via a unilateral axillo-breast approach without gas insufflation were enrolled in this study. Our indications for endoscopic thyroid surgery were as follows：1) benign nodules less than 6 cm in diameter, 2) follicular neoplasm less than 6 cm in diameter, and 3) only unilateral thyroid lesions. The following variables were examined：perioperative complications, operation time, diameter of resected thyroid nodule, permanent pathology, time of hospital discharge after operation, duration of drain placement, and total amount of drainage. Results：Postoperative pathology revealed 8 follicular adenomas, 31 nodular hyperplasias, and 2 lymphocytic thyroiditis. The operating time in the first 10 hemithyroidectomies was 154.0±64.88 min, which was 38.07 min longer than in the last 31 hemithyroidectomies (115.93±32.64 min；p=0.1426). The amount and duration of postoperative drainage were 249.34± 118.47 mL in 4.01±1.31 days, respectively. The postoperative hospital stay was 6.12±1.99 days. Overall, perioperative complications occurred in seven patients (7/41, 17.1%), including one transient recurrent laryngeal nerve palsies (2.4%), five seromas (12.2%), and one hematoma (2.4%), which arose from a subplatysmal skin flap. Conclusion：These results suggest that endoscopic hemithyroidectomy via a unilateral axillo-breast approach without gas insufflation is safe and effective in selective unilateral benign thyroid lesions and appears to provide better cosmetic results and a shorter operation time than other endoscopic thyroidectomy methods. However, more invasiveness due to significant dissection aimed at obtaining an adequate working space and longer operation time needed than with either traditional open surgery or the minimally invasive video assisted technique should be overcome through accumulation of experience. (Korean J Otorhinolaryngol-Head Neck Surg 2008;51:805-11)
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