Retro-auricular video-assisted "gasless" thyroidectomy: feasibility study in human cadavers

Abstract

Background: In recent years, there has been a surge of interest in developing alternative surgical approaches to the thyroid gland with a focus on cosmesis. Approaches can be either complete endoscopic approaches using CO(2) insufflation or endoscopy-assisted approaches. We describe a novel approach for thyroidectomy via a retro-auricular incision without gas insufflation using endoscopic assistance.

Methods: Six fresh human cadavers were utilized. Four head and neck specimens were used to assess the retro-auricular approach and the creation of surgical space in the lower neck. Three hemithyroidectomy in two fresh human cadavers procedures were performed via a retro-auricular approach. The end-point of the study was successful removal of the hemithyroid gland with preservation of the recurrent laryngeal nerve.

Results: In all cases, the retro-auricular flap and subplatysmal plane could be achieved without difficulty. Three hemithyroid specimens were successfully removed in two cadaveric specimens using the retro-auricular approach with endoscopic guidance. Thyroid gland resection with identification and preservation of the recurrent laryngeal nerve could be achieved in all three procedures (100%).

Conclusion: The retro-auricular approach or the "Walvekar approach" permits adequate working space and an excellent endoscopic surgical view for removal of the ipsilateral hemithyroid gland with an option for a bilateral approach using a "gasless technique."