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Endoscopic Thyroid Surgeries via Areola Approach: Experience and Outcomes of 500 Cases in a Single Institute

  • Rui Qu
  • Youming Guo
  • Xiaochi Hu
  • Libo Luo
  • Daosheng Liu
Original Article
  • 26 Downloads

Abstract

With the growing popularity of endoscopic thyroid surgery for treatment of thyroid diseases, this study aimed to summarize our experience of endoscopic thyroidectomy (ETE), and evaluate the feasibility and safety of ETE, in our institute. Five hundred patients underwent ETE via the areola approach. The learning curve, clinicopathologic characteristics, cosmetic satisfaction, complications, and so on were analyzed. Among the 500 cases, 497 were successfully managed with ETE, and 3 were converted to open procedure. The score of cosmetic satisfaction, average operation time, tumor diameter, mean total intra-operative blood loss, hospital stay, drainage time, and age were 9.4 ± 0.5, 142 ± 20 min, 2.6 ± 1.2 cm, 34 ± 12 ml, 11.4 ± 3.6 days, 3.3 ± 0.7 days, and 44.2 ± 11.9 years, respectively. Pathological types of the tumor included papillary thyroid carcinoma (PTC; n = 87), nodular goiters (n = 283), follicular adenoma (n = 84), and others (n = 46). The complications included transient recurrent laryngeal nerve (RLN) palsy (n = 15, 3.0%), transient superior laryngeal nerve (SLN) palsy (n = 3, 0.6%), transient hypoparathyroidism (n = 32, 6.4%), tracheal injury (n = 1, 0.2%), swallowing discomfort (n = 20, 4.0%), infection (n = 7, 1.4%), and others (n = 15, 3.0%). No patients experienced permanent RLN injury or SLN injury, asphyxia/dyspnea, esophagus injury, bleeding, chylous fistula, or death. Among the cases of PTC, 76 (87.4%) cases underwent the central lymph node dissection. The mean number of retrieved lymph nodes was 6.4 ± 2.1, while the mean number of metastatic central lymph nodes was 1.2 ± 2.3. The ratios of capsule invasion, central lymph node metastasis, and extrathyroidal extension were 10.3, 26.4, and 3.4%. ETE via areola approach is safe, feasible, and cosmetic, with good operative results and low complication rates. It provides an effective choice for treating patients.

Keywords

Endoscopic surgery Thyroidectomy Papillary thyroid cancer Areola approach 

Notes

Funding

This work was funded by the Major Project from Technology and Science Bureau of Zunyi City, China (NO. 2014-25).

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

References

  1. 1.
    Gagner M (1996) Endoscopic subtotal parathyroidectomy in patients with primary hyperparathyroidism. Br J Surg 83(6):875CrossRefPubMedGoogle Scholar
  2. 2.
    Ileda Y, Takami H, Sasaki Y, Takayama J, Niimi M, Kan S (2002) Comparative study of thyroidectomies: endoscopic surgery vs conventional open surgery. Surg Endosc 16:1741–1745CrossRefGoogle Scholar
  3. 3.
    Cao F, Xie B, Cui B, Xu D (2011) Endoscopic vs. conventional thyroidectomy for the treatment of benign thyroid tumors: a retrospective study of a 4-year experience. Exp Ther Med 2:661–666CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Chung YS, Choe JH, Kang KH, Kim SW, Chung KW, Park KS, Han W, Noh DY, Oh SK, Youn YK (2007) Endoscopic thyroidectomy for thyroid malignancies: comparison with conventional open thyroidectomy. World J Surg 31:2302–2306CrossRefPubMedGoogle Scholar
  5. 5.
    Lu JH, Materazzi G, Miccoli M, Baggiani A, Hu S, Miccoli P (2012) Minimally invasive video assisted thyroidectomy versus endoscopic thyroidectomy via the areola approach: a retrospective analysis of safety, postoperative recovery, and patient satisfaction. Minerva Chir 67:31–37PubMedGoogle Scholar
  6. 6.
    Pellegriti G, Frasca F, Regalbuto C, Squatrito S, Vigneri R 2013 Worldwide increasing incidence of thyroid cancer: update on epidemiology and risk factors. J Cancer Epidemiol 965212, 2013, 1, 10Google Scholar
  7. 7.
    Choe JH, Kim SW, Chung KW, Park KS, Han W, Noh DY, Oh SK, Youn YK (2007) Thyroidectomy using a new bilateral axillo-breast approach. World J Surg 31:601–606CrossRefPubMedGoogle Scholar
  8. 8.
    Choe J-H, Kim SW, Chung K-W, Park KS, Han W, Noh DY, Oh SK, Youn YK (2007) Endoscopic thyroidectomy using a new bilateral axillo-breast approach. World J Surg 31(3):601–606CrossRefPubMedGoogle Scholar
  9. 9.
    Shindo M, Wu JC, Park EE, Tanzella F (2006) The importance of central compartment elective lymph node excision in the staging and treatment of papillary thyroid cancer. Arch Otolaryngol Head Neck Surg 132(6):650–654CrossRefPubMedGoogle Scholar
  10. 10.
    Miccoli P, Elisei R, Materazzi G, Capezzone M, Galleri D, Pacini F, Berti P, Pinchera A (2002) Minimally invasive video-assisted thyroidectomy for papillary carcinoma: a prospective study of its completeness. Surgery 132(6):1070–1074CrossRefPubMedGoogle Scholar
  11. 11.
    Yang Y, Gu X, Wang X, Xiang J, Chen Z 2012 Endoscopic thyroidectomy for differentiated thyroid cancer. Sci World J 456807Google Scholar
  12. 12.
    Smith BR, Cooper DS, Doherty GM, Haugen BR, Kloos RT, Lee SL, Mandel SJ, Mazzaferri EL, McIver B, Sherman SI, Tuttle RM (2006) American Thyroid Association Guidelines Taskforce. Management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid 16:109CrossRefGoogle Scholar
  13. 13.
    Gao WL, Liu LW, Ye GC (2015) Bilateral areolar approach endoscopic thyroidectomy for low-risk papillary thyroid carcinoma: a review of 137 cases. Surg Laparosc Endosc Percutan Tech 25(1):19–22CrossRefPubMedGoogle Scholar
  14. 14.
    Leong S, Cahill RA, Mehigan BJ, Stephens RB (2007) Considerations on the learning curve for laparoscopic colorectal surgery: a view from the bottom. Int J Color Dis 22:1109–1115CrossRefGoogle Scholar
  15. 15.
    Ozturk E, da Luz Moreira A, Vogel JD (2010) Hand-assisted laparoscopic colectomy: the learning curve is for operative speed, not for quality. Color Dis 12:304–309CrossRefGoogle Scholar
  16. 16.
    Moore MJ, Bennett CL (1995) The learning curve for laparoscopic cholecystectomy. The Southern Surgeons Club Am J Surg 170:55–59PubMedGoogle Scholar
  17. 17.
    Zhang X, Tanigawa N (2009) Learning curve of laparoscopic surgery for gastric cancer, a laparoscopic distal gastrectomy-based analysis. Surg Endosc 23:1259–1264CrossRefPubMedGoogle Scholar
  18. 18.
    Cao F, Jin K, Cui B, Xie B (2013) Learning curve for endoscopic thyroidectomy: a single teaching hospital study. Onco Targets Ther 6:47–52PubMedPubMedCentralGoogle Scholar
  19. 19.
    Liu S, Qiu M, Jiang DZ, Zheng XM, Zhang W, Shen HL, Shan CX (2009) The learning curve for endoscopic thyroidectomy: a single surgeon’s experience. Surg Endosc 23:1802–1806CrossRefPubMedGoogle Scholar
  20. 20.
    Hu YZ, Wang CC, Li GX (2012) Learning curve of endoscopic thyroidectomy by complete areola approach. J Jinan Univ 33:597–600Google Scholar
  21. 21.
    Hyun K, Byon W, Park HJ, Park Y, Park C, Yun JS (2014) Comparison of swallowing disorder following gasless transaxillary endoscopic thyroidectomy versus conventional open thyroidectomy. Surg Endosc 28:1914–1920CrossRefPubMedGoogle Scholar
  22. 22.
    Wang C, Sun P, Li J (2016) Strategies of laparoscopic thyroidectomy for treatment of substernal goiter via areola approach. Surg Endosc 30:4721–4730CrossRefPubMedGoogle Scholar
  23. 23.
    Wang C, Feng Z, Li J, Yang W, Zhai H, Choi N, Yang J, Hu Y, Pan Y, Cao G (2015) Endoscopic thyroidectomy via areola approach: summary of 1,250 cases in a single institution. Surg Endosc 29:192–201CrossRefPubMedGoogle Scholar
  24. 24.
    Zhang W, Jiang DZ, Liu S, Li LJ, Zheng XM, Shen HL, Shan CX, Qiu M (2011) Current status of endoscopic thyroid surgery in China. Surg Laparosc Endosc Percutan Tech 21(2):67–71CrossRefPubMedGoogle Scholar
  25. 25.
    Li-Tsang CW, Lau JC, Chan CC (2005) Prevalence of hypertrophic scar formation and its characteristics among the Chinese population. Burns 31:610–616CrossRefPubMedGoogle Scholar
  26. 26.
    Ito Y, Tomoda C, Uruno T, Takamura Y, Miya A, Kobayashi K, Matsuzuka F, Kuma K, Miyauchi A (2006) Clinical significance of metastasis to the central compartment from papillary microcarcinoma of the thyroid. World J Surg 30(1):91–99CrossRefPubMedGoogle Scholar
  27. 27.
    Choi JY, Lee KE, Chung KW, Kim SW, Choe JH, Koo DH, Kim SJ, Lee J, Chung YS, Oh SK, Youn YK (2012) Endoscopic thyroidectomy via bilateral axillo-breast approach (BABA): review of 512 cases in a single institute. Surg Endosc 26:948–955CrossRefPubMedGoogle Scholar
  28. 28.
    Farrag T, Lin F, Brownlee N, Kim M, Sheth S, Tufano RP (2009) Is routine dissection of level II-B and V-A necessary in patients with papillary thyroid cancer undergoing lateral neck dissection for FNA-confirmed metastases in other levels. World J Surg 33:1680–1683CrossRefPubMedGoogle Scholar

Copyright information

© Association of Surgeons of India 2018

Authors and Affiliations

  • Rui Qu
    • 1
    • 2
  • Youming Guo
    • 2
  • Xiaochi Hu
    • 2
  • Libo Luo
    • 2
  • Daosheng Liu
    • 2
  1. 1.Department of General SurgeryFirst Affiliated Hospital of Jinan UniversityGuangzhouChina
  2. 2.Department of Thyroid SurgeryFirst People’s Hospital of Zunyi CityZunyiChina

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