Gasless single incision endoscopic thyroidectomy

Abstract

Background: Endoscopic thyroidectomy making the scar outside the neck area has a cosmetic appeal for patients. Based on an anterior chest wall approach combined with the gasless technique, we developed a novel method for gasless endoscopic thyroidectomy with a single incision.

Materials and methods: From March 2009 to November 2010, 48 patients with benign thyroid nodules underwent thyroidectomy with the gasless single-incision endoscopic surgery technique via the anterior chest wall approach. A 3-cm long skin incision parallel to the clavicle was made on the anterior chest wall on the side of the lesion. The platysma flap was lifted up to maintain working space from the incision to the thyroid cartilage. Dissection of the thyroid was begun from the inferior pole of the thyroid. The line of resection was selected to preserve recurrent laryngeal nerve and parathyroids. A 5-mm drainage tube was inserted into the lower portion of the operative space through the incision after the thyroid gland and the lesion were resected using the Harmonic scalpel.

Results: The overall operating time was 126 minutes (range, 90 to 210), 138 minutes (range, 80 to 160) in first 24 cases; and 112 minutes in the second 24 patients (P<.05). Three cases were converted to the conventional procedure: 2 because of a malignancy diagnosed on frozen section, and one due to uncontrolled bleeding from the middle thyroid vein. Another malignancy diagnosed on final pathological examination was treated with additional surgery to complete the thyroidectomy by using the conventional open method. There were 2 cases of postoperative complications: transient hoarseness and hematoma. No wound infection occurred in our series. The scar was well hidden beneath the clothes, and the patients were satisfied with the cosmetic result of the surgery.

Conclusions: Advantages of the chest wall approach combined with the gasless technique have made singleincision endoscopic thyroidectomy more feasible and practicable.

Figure 1.

Dissecting stick was inserted through skin incision subcutaneously above the pectoralis major muscle advancing upwardly towards the subplatysmal plane.

Figure 2.

The lifting device was installed to lift up the platysma flap, and then the working space was created from the anterior chest wall to the thyroid cartilage level.

Figure 3.

A ligator was used to ligate the vessels using thread.

Figure 4.

The vessels were ligated by thread with the finger.

Figure 5.

The resected specimen was retrieved through the skin incision on the anterior chest wall.

Figure 6.

Drainage tube was inserted through the incision.

Figure 7.

Dissecting and dividing by Harmonic scalpel. Three instruments were simultaneously inserted through the incision.