Journal List > Korean J Endocr Surg > v.15(2) > 1060143

Park, Ryu, Cho, Yoon, and Park: A Clinical Analysis of Endoscopic Thyroidectomy via Bilateral Axillobreast Approach: A 5-year Experience

Abstract

Purpose

We investigated the efficacy and safety of endoscopic thyroidectomy using bilateral Axillobreast approach (BABA) by analyzing short term surgical outcomes.

Methods

We retrospectively evaluated 355 patients who underwent BABA endoscopic thyroidectomy between August 2006 and December 2011 at Chonnam National University Hospital and Hwasun Chonnam National University Hospital. The age, sex, clinical and pathologic characteristics of tumors, extent of operation, conversion rate to open thyroidectomy, operation time, hospital stay, thyroglobulin levels after thyroidectomy, recurrence, and complications were analyzed retrospectively.

Results

The mean age of the patients was 35 years. The 355 patients comprised 345 females (97.2%) and 10 males (2.8%). The benign tumor was 37 cases (10.4%) and the malignant tumor was 318 cases (89.6%). 28 patients (75.7%) of the benign tumor underwent lobectomy. In malignant tumor, 159 patients (50.0%) underwent lobectomy and 152 patients (47.8%) underwent total thyroidectomy. Mean operation time was 121.1±49.9 minutes, and mean hospital days were 3.4±1.1 days. 21 (6.0%) transient hypocalcemia and 7 (2.0%) permanent hypocalcemia were occurred. The transient voice change occurred in 5 patients (1.4%), but nobody suffered from the permanent recurrent laryngeal nerve injury. 4 patients of recurrent (1.3%) papillary thyroid carcinoma were treated by surgery.

Conclusion

Compare to open thyroidectomy with long term follow up studies, BABA endoscopic thyroidectomy is a useful treatment option for both benign and malignant thyroid tumor.

References

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Table 1.
Demographics and clinical results of the patients who underwent BABA endoscopic thyroidectomy
Clinicopathologic characteristic Value
Age (years) 35.3±8.2 (range 14∼58)
 45 years and older in malignancy 44 (13.8%)
Sex  
 Male 10 (2.8%)
 Female 345 (97.2%)
Tumor location  
 Right 174 (49.0%)
 Left 142 (40.0%)
 Isthmus 23 (6.5%)
 Both 16 (4.5%)
Mean tumor size (cm)  
 Benign 2.2±1.2 (range 0.4∼5.0)
 Malignancy 0.7±0.5 (range 0.1∼6.0)
Pathologic classification  
 Nodular hyperplasia 22 (6.2%)
 Follicular adenoma 12 (3.4%)
 Hürthle cell adenoma 3 (0.8%)
 Papillary thyroid carcinoma 315 (88.7%)
 Follicular thyroid carcinoma 3 (0.8%)
Retrieved central lymph node count 3.9±3.4 (range 1∼19)
 Pathologic positive 2.7±2.5 (range 1∼12)
TNM classification 318
 T1a 274 (86.2%)
 T1b 27 (8.5%)
 T2 5 (1.6%)
 T3 12 (3.8%)
 N0 112 (31.5%)
 N1a 37 (10.5%)
 Nx 206 (58.0%)
 Stage I 313 (98.4%)
 Stage II 5 (1.6%)
Thyroiditis 101 (28.5%)
Postoperative RAI therapy (n=160) 60 (37.5%)
Postoperative Tg<1 ng/mL (n=154) 145 (94.2%)
Operation related complication 37 (10.5%)
Recurrence 4 (1.3%)

RAI = Radioactive iodine; Tg = thyroglobulin.

Table 2.
Type of operation
  Benign (37) Malignancy (316)
Lobectomy 28 (77.8%) 93 (29.4%)
Lobectomy with CLND   66 (20.9%)
Isthmusectomy 4 (11.1%) 4 (1.3%)
Subtotal thyroidectomy 1 (2.8%) 1 (0.3%)
Total thyroidectomy 3 (8.3%) 76 (24.1%)
Total thyroidectomy with CLND   76 (24.1%)

CLND = central lymph node dissection.

Table 3.
Complications related to operation
  Number (%)
Transient hypocalcemia 21 (6.0%)
Permanent hypocalcemia 7 (2.0%)
Transient RLN palsy 5 (1.4%)
Permanent RLN palsy 0
External jugular vein injury 1 (0.3%)
Postoperative bleeding 0
Tracheal injury 1 (0.3%)
Esophageal injury 0
Horner's syndrome 1 (0.3%)
Skin pigmentation 1 (0.3%)
Wound infection 0

RLN = recurrent laryngeal nerve.

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