Endoscopic thyroidectomy via areola approach: summary of 1,250 cases in a single institution



The aim of this study was to evaluate the effect and cosmetic results of endoscopic thyroidectomy (ETE) via the areola approach for patients with thyroid diseases.


A total of 1,250 patients with thyroid diseases underwent ETE via the areola approach between April 2005 and January 2011. Of these, 898 were benign goiters, 260 were Graves’ disease, 28 were secondary hyperthyroidism, and 64 were papillary carcinomas.


The surgery was successfully completed in 1,249 cases, and 1 case was converted to open surgery. The mean operation time, estimated blood loss, and hospital stay after surgery for patients with a goiter, hyperthyroidism, and papillary carcinoma were 94.4 min, 15.2 ml, 5.0 days, 97.9 min, 16.1 ml, 5.5 days, and 134.3 min, 18.6 ml, 6.4 days, respectively. Complications included 4 cases of postoperative bleeding, 1 case of transection of the recurrent laryngeal nerve (RLN) on one side, 7 cases of temporary RLN injury, 34 cases of transient hypocalcemia, 5 cases of skin bruising on the chest wall, and 1 case of subcutaneous infection in the neck. At 4.6-year (2.5–8 years) follow-up of 1,185 (94.8 %) patients, 3 patients with Graves’ disease had recurrence of hyperthyroidism, and 4 patients with nodular goiter had recurrence of small nodules. Four patients had discomfort on swallowing, 4 patients had an abnormal sensation of skin traction on the neck and the chest, and 1 patient with scar diathesis had mild scar hyperplasia. A total of 876 patients were satisfied, 4 equivocal, and 0 unsatisfied with the cosmetic results.


ETE via the areola approach for patients with benign goiters, Graves’ disease, secondary hyperthyroidism, and papillary carcinomas without metastasis to lateral cervical lymph nodes is an effective and safe procedure with excellent cosmetic results.

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  1. 1.

    Gagner M (1996) Endoscopic subtotal parathyroidectomy in patients with primary hyperparathyroidism. Br J Surg 83:875

    CAS  PubMed  Article  Google Scholar 

  2. 2.

    Huscher CS, Chiodini S, Napolitano C, Recher A (1997) Endoscopic right thyroid lobectomy. Surg Endosc 11:877

    CAS  PubMed  Article  Google Scholar 

  3. 3.

    Miccoli P, Berti P, Raffaelli M, Conte M, Materazzi G, Galleri D (2001) Minimally invasive video-assisted thyroidectomy. Am J Surg 181:567–570

    CAS  PubMed  Article  Google Scholar 

  4. 4.

    Shimizu K, Akira S, Tanaka S (1998) Video-assisted neck surgery: endoscopic resection of benign thyroid tumor aiming at scarless surgery on the neck. J Surg Oncol 69:178–180

    CAS  PubMed  Article  Google Scholar 

  5. 5.

    Ikeda Y, Takami H, Sasaki Y, Kan S, Niimi M (2000) Endoscopic neck surgery by the axillary approach. J Am Coll Surg 191:336–340

    CAS  PubMed  Article  Google Scholar 

  6. 6.

    Ohgami M, Ishii S, Arisawa Y, Ohmori T, Noga K, Furukawa T, Kitajima M (2000) Scarless endoscopic thyroidectomy: breast approach for better cosmesis. Surg Laparosc Endosc Percutan Tech 10:1–4

    CAS  PubMed  Google Scholar 

  7. 7.

    Sasaki A, Nakajima J, Ikeda K, Otsuka K, Koeda K, Wakabayashi G (2008) Endoscopic thyroidectomy by the breast approach: a single institution’s 9-year experience. World J Surg 32:381–385

    PubMed  Article  Google Scholar 

  8. 8.

    Cooper DS, Doherty GM, Haugen BR, Kloos RT, Lee SL, Mandel SJ, Mazzaferri EL, McIver B, Pacini F, Schlumberger M, Sherman SI, Steward DL, Tuttle RM, Ata (2009) Revised American Thyroid Association Management Guidelines for Patients with Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid 19:1167–1214

    PubMed  Article  Google Scholar 

  9. 9.

    Smith BR, Cooper DS, Doherty GM, Haugen BR, Kloos RT, Lee SL, Mandel SJ, Mazzaferri EL, McIver B, Sherman SI, Tuttle RM, Amer Thyroid Assoc Guidelines Taskforce (2006) Management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid 16:109

    Article  Google Scholar 

  10. 10.

    Singer PA, Cooper DS, Daniels GH, Ladenson PW, Greenspan FS, Levy EG, Braverman LE, Clark OH, McDougall IR, Ain KV, Dorfman SG (1996) Treatment guidelines for patients with thyroid nodules and well-differentiated thyroid cancer. American Thyroid Association. Arch Intern Med 156:2165–2172

    CAS  PubMed  Article  Google Scholar 

  11. 11.

    Sasaki A, Nakajima J, Ikeda K, Otsuka K, Koeda K, Wakabayashi G (2008) Endoscopic thyroidectomy by the breast approach: a single institution’s 9-year experience. World J Surg 32:381–385

    PubMed  Article  Google Scholar 

  12. 12.

    Miccoli P, Minuto MN, Ugolini C, Pisano R, Fosso A, Berti P (2008) Minimally invasive video-assisted thyroidectomy for benign thyroid disease: an evidence-based review. World J Surg 32:1333–1340

    PubMed  Article  Google Scholar 

  13. 13.

    Wang C-c, Yang J-g, Hu Y-z, Chen J, Xu P, Su C (2007) Endoscopic thyroidectomy via chest and breasts approach in 500 cases. Zhonghua er bi yan hou tou jing wai ke za zhi = Chin J Otorhinolaryngol Head Neck Surg 42:919–923

    Google Scholar 

  14. 14.

    Maeda S, Uga T, Hayashida N, Ishigaki K, Furui J, Kanematsu T (2006) Video-assisted subtotal or near-total thyroidectomy for Graves’ disease. Br J Surg 93:61–66

    CAS  PubMed  Article  Google Scholar 

  15. 15.

    Shimizu K, Tanaka S (2003) Asian perspective on endoscopic thyroidectom—a review of 193 cases. Asian journal of surgery/Asian Surgical Association 26:92–100

    PubMed  Article  Google Scholar 

  16. 16.

    Yamamoto M, Sasaki A, Asahi T, Shimada Y, Sato N, Nakajima J, Mashima R, Saito K (2001) Endoscopic subtotal thyroidectomy for patients with Graves’ disease. Surg Today 31:1–4

    CAS  PubMed  Article  Google Scholar 

  17. 17.

    Sasaki A, Nitta H, Otsuka K, Obuchi T, Kurihara H, Wakabayashi G (2009) Endoscopic subtotal thyroidectomy: the procedure of choice for graves’ disease? World J Surg 33:67–71

    PubMed  Article  Google Scholar 

  18. 18.

    Li ZY, Wang P, Wang Y, Xu SM, Cao LP, Que RS (2010) Endoscopic thyroidectomy via breast approach for patients with graves’ disease. World J Surg 34:2228–2232

    PubMed  Article  Google Scholar 

  19. 19.

    Wilhelm SM, McHenry CR (2010) Total thyroidectomy is superior to subtotal thyroidectomy for management of graves’ disease in the United States. World J Surg 34:1261–1264

    PubMed  Article  Google Scholar 

  20. 20.

    Stalberg P, Svensson A, Hessman O, Akerstrom G, Hellman P (2008) Surgical treatment of Graves’ disease: evidence-based approach. World J Surg 32:1269–1277

    PubMed  Article  Google Scholar 

  21. 21.

    Ku CF, Lo CY, Chan WF, Kung AWC, Lam KSL (2005) Total thyroidectomy replaces subtotal thyroidectomy as the preferred surgical treatment for Graves’ disease. Anz J Surg 75:528–531

    PubMed  Article  Google Scholar 

  22. 22.

    Sugino K, Ito K, Nagahama M, Kitagawa W, Shibuya H, Ito K (2008) Surgical management of Graves’ disease—10-year prospective trial at a single institution. Endocr J 55:161–167

    PubMed  Article  Google Scholar 

  23. 23.

    Dogan L, Karaman N, Yilmaz KB, Ozaslan C, Atalay C (2011) Total thyroidectomy for the surgical treatment of multinodular goiter. Surg Today 41:323–327

    PubMed  Article  Google Scholar 

  24. 24.

    Albayrak Y, Demiryilmaz I, Kaya Z, Aylu B, Guzel IC, Ozcan O, Aslan S, Yenisolak A, Ozturk M, Celik S (2011) Comparison of total thyroidectomy, bilateral subtotal thyroidectomy and Dunhill operations in the treatment of benign thyroid disorders. Minerva Chir 66:189–195

    CAS  PubMed  Google Scholar 

  25. 25.

    Agarwal G, Aggarwal V (2008) Is total thyroidectomy the surgical procedure of choice for benign multinodular goiter? An evidence-based review. World J Surg 32:1313–1324

    PubMed  Article  Google Scholar 

  26. 26.

    Bhattacharyya N (2003) Surgical treatment of cervical nodal metastases in patients with papillary thyroid carcinoma. Arch Otolaryngol Head Neck Surg 129:1101–1104

  27. 27.

    Kandil EH, Noureldine SI, Yao L, Slakey DP (2012) Robotic transaxillary thyroidectomy: an examination of the first one hundred cases. J Am Coll Surg 214:558–564

    PubMed  Article  Google Scholar 

  28. 28.

    Ryu HR, Kang S-W, Lee SH, Rhee KY, Jeong JJ, Nam K-H, Chung WY, Park CS (2010) Feasibility and safety of a new robotic thyroidectomy through a gasless, transaxillary single-incision approach. J Am Coll Surg 211:e13–e19

    PubMed  Article  Google Scholar 

  29. 29.

    Wang C, Zhai H, Liu W, Li J, Yang J, Hu Y, Huang J, Yang W, Pan Y, Ding H (2014) Thyroidectomy: a novel endoscopic oral vestibular approach. Surgery 155:33–38

    PubMed  Article  Google Scholar 

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This work was supported by Science and Technology Development Fund Project, Macao (Grant 027/2010/A).


Drs. Cunchuan Wang, Zhiqi Feng, Jinyi Li, Wah Yang, Hening Zhai, Nim Choi, Jingge Yang, Youzhu Hu, Yunlong Pan, and Guo Cao have no conflicts of interest or financial ties to disclose.

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Correspondence to Cunchuan Wang.

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Wang, C., Feng, Z., Li, J. et al. Endoscopic thyroidectomy via areola approach: summary of 1,250 cases in a single institution. Surg Endosc 29, 192–201 (2015). https://doi.org/10.1007/s00464-014-3658-8

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  • Endoscopic thyroidectomy
  • Areola approach
  • Benign thyroid disease
  • Papillary carcinoma