Endoscopic thyroidectomy via axillary-breast-shoulder approach: Early experience of 42 cases

• Published in: Surgical oncology Vol. 34; pp. 318 - 323
• Main Authors: Yulian, Erwin Danil, Kurnia, Ahmad, Kartini, Diani, Melati, Putri Arum
• Format: Journal Article
• Language: English
• Published: Oxford Elsevier Ltd 01.09.2020; Elsevier Limited
• Subjects: Aesthetics; Axillary-breast-shoulder approach; Breast; Carbon dioxide; Complications; Dissection; Drug dosages; Early experience; Emphysema; Endoscopic thyroidectomy; Endoscopy; Feasibility; General anesthesia; Hematoma; Hospitals; Lymphatic system; Malignancy; Minimally invasive thyroid surgery; Nodules; Pain; Patient satisfaction; Shoulder; Surgeons; Surgery; Surgical outcomes; Thyroid; Thyroid gland; Thyroidectomy; Tumors; Ultrasonic imaging; Indonesia; Axillary-breast-shoulder approach; Endoscopic thyroidectomy; Minimally invasive thyroid surgery
• ISSN: 0960-7404; 1879-3320; 1879-3320
• DOI: 10.1016/j.suronc.2020.05.007

Most patients in Indonesia present with large-sized thyroid nodules, which need surgical removal to exclude malignancy. Many surgeons prefer endoscopic thyroidectomy to avoid a large and visible surgical scar on the neck and to reduce postoperative complications. This study aims to evaluate and analyze surgical feasibility, safety, oncologic outcome, and patient satisfaction of endoscopic thyroidectomy via the axillary-breast-shoulder approach. Between August 2010 and September 2015, 42 endoscopic thyroidectomies via the axillary-breast-shoulder approach with carbon dioxide insufflation up to 8–10 mmHg were performed and retrospectively reviewed. Mean tumor size and operative time were 3.11 ± 0.99 cm and 189 ± 45 min, respectively. Mean blood loss was 68.3 mL. There were temporary complications such as hoarseness (19%), emphysema (2.3%) and hematoma (2.3%). Mean hospital length of stay was 3.98 days. Most subjects (61.9%) were very satisfied with the postoperative scar. The visual analog score of postoperative pain decreased from 4.83 on day-1 to 2.28 on day-7. The tumor recurrence was 9.6%. Endoscopic thyroidectomy via the axillary-breast-shoulder approach is feasible, safe, and minimally invasive with excellent postoperative results. •Axillary-breast approach is feasible, safe, and esthetically acceptable.•Axillary-breast approach requires experiences in conventional open thyroidectomy.•Patient safety is the priority to minimize mortality and complications.