Journal List > J Korean Surg Soc > v.79(6) > 1011201

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Kim, Kim, Kim, An, Bae, Park, and Kim: Clinical Comparative Evaluation of Open Method and Gasless or Gas Insufflation Anterior Chest Approach in Endoscopic Thyroidectomy in a Single Institution
Original Article
Journal of the Korean Surgical Society

Journal of the Korean Surgical Society 2010; 79(6): 447-454.

Published online: 31 December 2010

DOI: https://doi.org/10.4174/jkss.2010.79.6.447

Clinical Comparative Evaluation of Open Method and Gasless or Gas Insufflation Anterior Chest Approach in Endoscopic Thyroidectomy in a Single Institution

Mi-hyeong Kim, M.D., Tae-won Kim, M.D., Kee-hwan Kim, M.D., Ph.D., Chang-hyeok An, M.D., Ph.D., Ja-sung Bae, M.D., Ph.D., Woo-chan Park, M.D., Ph.D., Jeong-soo Kim, M.D., Ph.D.

Department of Surgery, The Catholic University of Korea College of Medicine, Uijeongbu, Korea.

Corresponding author (drbreast@catholic.ac.kr)

Received 6 August 2010       Accepted 28 September 2010

Copyright © 2010 The Korean Surgical Society

Abstract

Purpose

After the first endoscopic thyroidectomy by Huscher in 1997, several surgeons reported their experiences with endoscopic thyroidectomies. And these papers showed that clinical outcomes of endoscopic thyroidectomy are similar to conventional thyroidectomy. But, there was no randomized prospective trial to determine which approach of endoscopic thyroidectomy achieved better results. We evaluated clinical data of gasless and gas insufflation endoscopic thyroidectomies with conventional thyroidectomy to define its advantages or disadvantages.

Methods

Between 1999 and 2009, 1,117 patients underwent thyroidectomies (1,149 cases). 747 cases was performed by conventional open method, 402 cases by endoscopic thyroidectomy. Among them, 317 cases were operated by gasless techniques and 85 cases by carbon dioxide gas insufflation.

Results

Between conventional and endoscopic thyroidectomy groups, operation time, hospitalization period, tumor size, and number of retrieved lymph nodes were similar (P-value >0.05). Among 441 thyroid cancer patients, 19 had recurrence, of which 15/301 (4.98%) had conventional thyroidectomy, and 4/140 (2.85%) had endoscopic thyroidectomy. After postoperative radioactive iodine therapy, follow-up Tg levels were checked in 274 patients, the levels were <2.0 ng/ml in 87.63% (163/186) of patients after conventional thyroidectomies and in 93.18% (82/88) following endoscopic thyroidectomies. There were no significant differences (P-value=0.58). Complication incidences (hypocalcemia, hoarseness, bleeding, wound infection) in both groups were not significantly distinctive (P-value=0.58).

Conclusion

Minimally invasive techniques are generally applied even for malignancy in selected cases because of its advantages, such as cosmetic results. Through this study, we showed similar clinical outcomes of conventional and gasless or gas insufflations endoscopic thyroidectomy.

Keywords: Thyroid, Open thyroidectomy, Endoscopic thyroidectomy

Figures and Tables

Fig. 1
Gasless endoscopic thyroidectomy. Two ports and one retractor are ready for gasless endoscopic thyroidectomy, and one axilla port is added on this setting, if needed.
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Fig. 2
Four ports in gas insufflation endoscopic thyroidectomy. Endoscopic instruments access through 4 ports in axilla, areola, parasternum and midclavicular line.
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Table 1
Pathologic diagnosis
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Table 2
Comparison in open and endoscopic thyroidectomies
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*MRND = modified radical node dissection; †CLND = central lymph node dissection; ‡LN = lymph node.

Table 3
Comparison in gas and gasless endoscopic thyroidectomies
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*LN = lymph node.

Table 4
Comparison in malignancies in open and endoscopic thyroidectomies
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*LN = lymph node.

Table 5
Recurrence or metastasis of open and endoscopic thyroidectomies
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*LN = lymph node.

Table 6
Complications of open and endoscopic thyroidectomies
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