Thyroid Surgery: Single-Port Access Transaxillary Totally Endoscopic Thyroidectomy

Abstract

Since the first endoscopic thyroidectomy performed by Huscher et al. (Surg Endosc 11:877, 1997) in 1997, more than 20 different techniques of endoscopic thyroidectomy have been reported. Video-assisted minimal endoscopic thyroidectomy (Miccoli surgery) was first brought up by Miccoli et al. (J Endocrinol Invest 22:849–851, 1999), who accomplished the thyroidectomy through a 2–3 cm incision in neck with the help of endoscope. This surgery decreases the length of the incision in the neck with a better cosmetic result than traditional open surgery. After that, some different approaches of endoscopic thyroidectomy were reported. All of them shifted the incision from neck to more hidden or unexposed sites such as chest wall (Takami and Ikeda, ANZJ Surg 72:841–842, 2002), axillary (Ikeda et al., J Am Coll Surg 191:336–340, 2000) and breast (Ohgami et al., Surg Laparosc Endosc Percutan Tech 10:1–4, 2000) et al. The most obvious advantage of these surgeries is cosmesis. Although in experienced hands, the overall morbidity and mortality haven’t increased, some special complications such as seroma, metastasis along the path of tunnel was reported. Furthermore, robotic assisted endoscopic thyroidectomy was reported (Kang et al., Surgery 146:1048–1055, 2009; Kang et al., J Am Coll Surg 209:e1–e7, 2009; Lee et al., J Oncol 2012:734541, 2012). More complicated surgery such as thyroid carcinoma resection can be performed under robotic assisted endoscope due to its better flexibility. Recently, laparoendoscopic single-site thyroidectomy was reported by some authors (Youben et al., Surg Laparosc Endosc Percutan Tech 21:e192–e196, 2011; Lee et al., J Laparoendosc Adv Surg Tech A 20:839–842, 2010; Fan et al., J Laparoendosc Adv Surg Tech A 21:243–247, 2011). The indications were limited to unilateral benign lesions, such as adenoma or nodule. The procedure was partial lobectomy. Laparoendoscopic single-site thyroidectomy decreased the dissection space, which decreased the postoperative discomfort and complication, at the same time; one incision can achieve the best cosmetic results. During the procedure, the axillary approach was thought the best way although some authors reported breast approach and even trans-oral approach (Nakajo et al., Surg Endosc 27:1105–1110, 2013).So far, we have performed single incision transaxillary endoscopic thyroid lobectomy in more than ten cases with good results.