A Clinical Analysis of Endoscopic Thyroidectomy via Bilateral Axillobreast Approach: A 5-year Experience

Yun Chul Park; Young Jae Ryu; Jin Seong Cho; Jung Han Yoon; Min Ho Park

doi:10.16956/kjes.2015.15.2.41

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

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

Original Article

Korean J Endocrine Surg 2015;15(2):41-46.

Published online: 10 December 2015

DOI: https://doi.org/10.16956/kjes.2015.15.2.41

A Clinical Analysis of Endoscopic Thyroidectomy via Bilateral Axillobreast Approach: A 5-year Experience

Yun Chul Park, Young Jae Ryu, Jin Seong Cho, Jung Han Yoon, Min Ho Park

Department of Surgery, Chonnam National University Medical School, Gwangju, Korea

Correspondence: Min Ho Park Department of Surgery, Chonnam National University Medical School, 160 Baekseo-ro, Dong-gu, Gwangju 501-746, Korea Tel: ＋82-61-379-7646 Fax: ＋82-61-379-7661 e-mail: mhpark@chonnam.ac.kr

Received 4 May 2015 Revised 19 May 2015 Accepted 30 May 2015

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.

Keywords: Endoscopic thyroidectomy, Bilateral axillo breast approach

References

1. Chen AY, Jemal A, Ward EM. Increasing incidence of differentiated thyroid cancer in the United States, 1988–2005. Cancer. 2009; 115:3801–7.

2. Gagner M. Endoscopic subtotal parathyroidectomy in patients with primary hyperparathyroidism. Br J Surg. 1996; 83:875.

3. Hüscher CS, Chiodini S, Napolitano C, Recher A. Endoscopic right thyroid lobectomy. Surg Endosc. 1997; 11:877.

4. Choe JH, Kim SW, Chung KW, Park KS, Han W, Noh DY, et al. Endoscopic thyroidectomy using a new bilateral axillobreast approach. World J Surg. 2007; 31:601–6.

5. Yoon JH, Park CH, Chung WY. Gasless endoscopic thyroidectomy via an axillary approach: experience of 30 cases. Surg Laparosc Endosc Percutan Tech. 2006; 16:226–31.

6. Kang SW, Jeong JJ, Yun JS, Sung TY, Lee SC, Lee YS, et al. Robot-assisted endoscopic surgery for thyroid cancer: experience with the first 100 patients. Surg Endosc. 2009; 23:2399–406.

7. Yoo H, Chae BJ, Park HS, Kim KH, Kim SH, Song BJ, et al. Comparison of surgical outcomes between endoscopic and robotic thyroidectomy. J Surg Oncol. 2012; 105:705–8.

8. American Thyroid Association (ATA) Guidelines Taskforce on Thyroid Nodules and Differentiated Thyroid Cancer. Cooper DS, Doherty GM, Haugen BR, Kloos RT, Lee SL, et al. Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid. 2009; 19:1167–214.

9. Cho JS, Yoon JH, Park MH, Shin SH, Jegal YJ, Lee JS, et al. Observational study of central metastases following thyroid lobectomy without a completion thyroidectomy for papillary carcinoma. J Korean Surg Soc. 2012; 83:196–202.

10. Edge SB, Compton CC. The American Joint Committee on Cancer: the 7th edition of the AJCC cancer staging manual and the future of TNM. Ann Surg Oncol. 2010; 17:1471–4.

11. Jung KW, Park S, Kong HJ, Won YJ, Lee JY, Seo HG, et al. Cancer statistics in Korea: incidence, mortality, survival, and prevalence in 2009. Cancer Res Treat. 2012; 44:11–24.

12. Cheon BS, Kim JH, Park KS, Bae SY, Jung SI, Yoo YB, et al. Endoscopic thyroidectomy via bilateral axillobreast approach in papillary thyroid carcinoma. Korean J Endocr Surg. 2011; 11:158–63.

13. Shimizu K, Akira S, Jasmi AY, Kitamura Y, Kitagawa W, Akasu H, et al. Video-assisted neck surgery: endoscopic resection of thyroid tumors with a very minimal neck wound. J Am Coll Surg. 1999; 188:697–703.

14. Inabnet WB 3rd, Jacob BP, Gagner M. Minimally invasive endoscopic thyroidectomy by a cervical approach. Surg Endosc. 2003; 17:1808–11.

15. Nakano S, Kijima Y, Owaki T, Shirao K, Baba M, Aikou T. Anterior chest wall approach for video-assisted thyroidectomy using a modified neck skin lifting method. Biomed Pharmacother. 2002; 56(Suppl 1):96s–9s.

16. Ikeda Y, Takami H, Sasaki Y, Kan S, Niimi M. Endoscopic neck surgery by the axillary approach. J Am Coll Surg. 2000; 191:336–40.

17. Ohgami M, Ishii S, Arisawa Y, Ohmori T, Noga K, Furukawa T, et al. Scarless endoscopic thyroidectomy: breast approach for better cosmesis. Surg Laparosc Endosc Percutan Tech. 2000; 10:1–4.

18. Lee KE, Kim HY, Park WS, Choe JH, Kwon MR, Oh SK, et al. Postauricular and axillary approach endoscopic neck surgery: a new technique. World J Surg. 2009; 33:767–72.

19. Chung YS, Choe JH, Kang KH, Kim SW, Chung KW, Park KS, et al. Endoscopic thyroidectomy for thyroid malignancies: comparison with conventional open thyroidectomy. World J Surg. 2007; 31:2302–6. discussion 2307–8.

20. Duh QY. Presidential Address: Minimally invasive endocrine surgery–standard of treatment or hype? Surgery. 2003; 134:849–57.

21. Miccoli P, Elisei R, Materazzi G, Capezzone M, Galleri D, Pacini F, et al. Minimally invasive video-assisted thyroidectomy for papillary carcinoma: a prospective study of its completeness. Surgery. 2002; 132:1070–3. discussion 1073–4.

22. Kim JH, Choi YJ, Kim JA, Gil WH, Nam SJ, Oh YL, et al. Thyroid cancer that developed around the operative bed and subcutaneous tunnel after endoscopic thyroidectomy via a breast approach. Surg Laparosc Endosc Percutan Tech. 2008; 18:197–201.

23. Lombardi CP, Raffaelli M, Princi P, De Crea C, Bellantone R. Minimally invasive video-assisted functional lateral neck dissection for metastatic papillary thyroid carcinoma. Am J Surg. 2007; 193:114–8.

24. Choi JY, Lee KE, Chung KW, Kim SW, Choe JH, Koo do H, et al. Endoscopic thyroidectomy via bilateral axillobreast approach (BABA): review of 512 cases in a single institute. Surg Endosc. 2012; 26:948–55.

25. Fewins J, Simpson CB, Miller FR. Complications of thyroid and parathyroid surgery. Otolaryngol Clin North Am. 2003; 36:189–206.

26. Harold KL, Pollinger H, Matthews BD, Kercher KW, Sing RF, Heniford BT. Comparison of ultrasonic energy, bipolar thermal energy, and vascular clips for the hemostasis of small-, medium-, and large-sized arteries. Surg Endosc. 2003; 17:1228–30.

27. Gottlieb A, Sprung J, Zheng XM, Gagner M. Massive subcutaneous emphysema and severe hypercarbia in a patient during endoscopic transcervical parathyroidectomy using carbon dioxide insufflation. Anesth Analg. 1997; 84:1154–6.

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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