갑상선 내시경 절제술: 액와부 접근법

Abstract

Background and Objectives：A hypertrophic scar of the anterior neck is the leading complaint of patients who underwentconventional thyroid surgery. In order to minimize the postoperative scars, endoscopic thyroidectomy via axillary approach wastried. Subjects and Method：Thirty-nine cases (female 37, male two, average age 36.3 yrs) with either benign unilateral thyroidnodule or cyst underwent endoscopic thyroidectomy. Under general anesthesia, less than 7 cm of skin incision was made inthe axilla of the same side and subcutaneous tunnel was made over the clavicle. Specially created retractor was placed within thetunnel between platysma and sternocleodomastoid muscle, and under rigid endoscope (4 mm, 5 mm；0°, 30°) thyroidectomywas performed. Results：There were 35 cases of thyroid nodulectomy, one case of isthmusectomy, and three cases of subtotallobectomy. Complete enucleations with the intact capsule were 13 cases, 24 cases with partial rupture of the capsule, and twocases with incomplete removal of the capsule. The mean operative time was 112.5 minutes. Postoperative complications includedone case of postoperative bleeding, two cases of delayed wound healing, three cases of paresthesia of shoulder and arm, and fivecases of hypertrophic scar of the axilla. For all cases, hospitalization period was two days. Conclusion：Endoscopic thyroidectomyvia axillary approach has an excellent cosmetic advantage；however, the procedure requires longer operation time ofabout three times the conventional method. Operation time can be reduced with the development of more versatile surgical tools.However, limited thyroidectomy surgery can not be avoided. (Korean J Otolaryngol 2006;49:527-31)