Drainage During Endoscopic Thyroidectomy

Abstract

Background: Conventional cervical drainage tubes are placed crossing the suprasternal fossa during endoscopic thyroidectomy. In our clinical experience, some patients show shallow or absent suprasternal fossa, which affects the cosmetic outcome in the patient. Therefore, this study aimed to assess the feasibility and significance of restoring the suprasternal fossa by changing the position of neck drainage tubes.

Methods and materials: A total of 117 female patients were enrolled and divided into 2 groups, including 59 and 58 individuals in the Conventional (conventional anterior neck region negative pressure drainage) and Improvement (improved method with a negative pressure drainage) groups. Then, restoration of the suprasternal fossa in all subjects was observed at 1 day postsurgery, the day of extubation, and 3 months postoperatively. In addition, drainage volume, the time to extubation, and abnormal neck sensations were compared between the groups.

Results: Compared with the Conventional group, the Improvement group showed improved restoration of the suprasternal fossa, with the patients more satisfied with the cosmetic outcome. However, operation time, postoperative drainage volume, and extubation time were not significantly different between the 2 groups.

Conclusions: In endoscopic thyroidectomy via the chest and breast approach, using the new drainage technique described here could yield improved restoration of the suprasternal fossa, ameliorating the cosmetic outcome and patient satisfaction.

Keywords: Aesthetics; Drainage tube; Endoscopy; Suprasternal fossa; Thyroid.

Figure 1.

Preoperative port sites placement. (A) A 1–1.5-cm incision was made 1–2 cm slightly to the right of the center of the cleavage while 0.5-cm incisions were made around the right and left areolas for the trocars.

Figure 2.

Endoscopic thyroidectomy with improved drainage. (A) At the level of the intersection of the inner 1/3 or 1/4 right clavicle, the superficial layers of the deep and superficial fasciae (cervical platysma and subcutaneous tissues) were sutured, dividing the subcutaneous space into middle and two lateral channels. (B) The drainage tubes were placed in the external lateral channel, bypassing the suprasternal fossa, in the deep surface of the strap muscles of the operation area. SM, sternocleidomastoid muscle; C, clavicle; SF, suprasternal fossa.

Figure 3.

Endoscopic thyroidectomy with the conventional drainage. The drainage tubes were placed across the suprasternal fossa and fixed via the incision on the right areola. SM, sternocleidomastoid muscle; SF, suprasternal fossa.

Figure 4.

(A) Conventional drainage tube placement. (B) Improved placement of drainage tube.

Figure 5.

Representative cosmetic outcome after endoscopic thyroidectomy via the chest and breast approach with improved drainage. (A) The suprasternal fossa in the experimental group before the operation. (B) Restoration situation of the suprasternal fossa 1 day postsurgery (score, 3 points). (C) Restoration situation of the suprasternal fossa after extubation (score, 2 points). (D) Restoration situation of the suprasternal fossa 3 months after surgery (score, 3 points).

Figure 6.

Flow of participants divided into the conventional or improved drainage groups.