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Comparative Study
. 2012 Dec 12:10:269.
doi: 10.1186/1477-7819-10-269.

Comparative study comparing endoscopic thyroidectomy using the axillary approach and open thyroidectomy for papillary thyroid microcarcinoma

Hayemin Lee  1 , Jina Lee, Ki Young Sung
Affiliations
Comparative Study

Comparative study comparing endoscopic thyroidectomy using the axillary approach and open thyroidectomy for papillary thyroid microcarcinoma

Hayemin Lee et al. World J Surg Oncol. .

Abstract

Background: Endoscopic thyroidectomy has been applied prudently to malignant thyroid tumors. The purpose of our study was to compare the surgical outcomes of endoscopic thyroidectomy (ET) and conventional open thyroidectomy (COT) for micropapillary thyroid carcinoma.

Methods: From October 2002 to December 2008, 78 patients underwent unilateral lobectomy and isthmectomy with central lymph node dissection for papillary thyroid microcarcinoma. Of these, 37 patients underwent ET and 41 patients COT. Surgical outcomes, including operation time, number of retrieved lymph nodes, postoperative complication rate and patients' satisfaction with the cosmetic results, were analyzed.

Results: The mean age of the patients was 42.3 ± 7.6 years in the ET group and 49.0 ± 10.8 years in the OT group (P = 0.003). The operation time was shorter in the COT group (112.3 ± 14 min) than in the ET group (138.4 ± 36.9 min, P< 0.01). However, there were no significant differences in tumor size (0.5 ± 0.231 vs. 0.41 ± 0.264 cm, P = 0.116), number of retrieved lymph nodes (3.63 ± 2.1 vs. 3.82 ± 3.28, P = 0.78) or postoperative hospital stay (3.35 ± 0.94 vs. 3.17 ± 1.16 days, P = 0.457). Patients in the ET group experienced more pain than those in the COT group at 1 and 7 days after the operation as evaluated by a visual analog scale (P = 0.037, 0.026). Cosmetically, patients in the ET group were very satisfied with the operative procedure according to the questionnaire we used (1.43 ± 0.55 vs. 3.21 ± 0.72, P< 0.001). The mean follow-up period was 54.3 months in the ET group and 47.4 months in the COT group, and each group exhibited one case of tumor recurrence detected at the other thyroid lobe within 2 years.

Conclusions: Large series of prospective studies and long-term follow-up are needed, but the results of ET using the axillary approach for micropapillary thyroid carcinoma were not inferiortothose using COT, and it might be a safe and feasible procedure with good cosmetic results.

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Figures

Figure 1
Figure 1
Operative view of ipsilateral axillary approach endoscopic thyroidectomy. Two trocars (5mm and 10mm) are inserted through axillary incisions. CO2 gas is insufflated via one 10-mm trocar, and the 10-mm rigid endoscope is inserted via this trocar.
Figure 2
Figure 2
Lateral view of the operative field during the operation. The recurrent laryngeal nerve was separated carefully from the thyroid gland, and the inferior thyroid artery, which crossed the recurrent laryngeal nerve,was divided with a harmonic scalpel. a Superior parathyroid gland; b inferior thyroid artery; c recurrent laryngeal nerve.
Figure 3
Figure 3
Incision for conventional open thyroidectomy. The length of the incision is 6.0 cm.
Figure 4
Figure 4
Macroscopic view of the neck and axilla 6 months after endoscopic thyroidectomy using the axillary approach.
See this image and copyright information in PMC

References

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