World Journal of Endocrine Surgery

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VOLUME 12 , ISSUE 2 ( May-August, 2020 ) > List of Articles

Original Article

Transaxillary Endoscopic Thyroidectomy: An Early Learning Experience from Singapore

Saleem AA Kareem, Clement Chia

Citation Information : Kareem SA, Chia C. Transaxillary Endoscopic Thyroidectomy: An Early Learning Experience from Singapore. World J Endoc Surg 2020; 12 (2):60-65.

DOI: 10.5005/jp-journals-10002-1298

License: CC BY-NC 4.0

Published Online: 16-01-2020

Copyright Statement:  Copyright © 2020; The Author(s).


Background: The pursuit of cosmesis and patient satisfaction has led surgeons to push the boundaries of minimally invasive thyroid surgery. We studied the feasibility, results, cosmesis, and patient satisfaction with scarless endoscopic thyroidectomy (SET) using an axillary-breast approach with particular emphasis on initial learning outcomes. Materials and methods: Between January 2016 and 2017, 13 patients (M = 3, F = 10) who met the eligibility criteria that included symptomatic unilateral benign nodules <6 cm (cyst, follicular neoplasm, adenomatous goiter), multinodular goiter, and differentiated microcarcinoma with low risk were offered endoscopic hemithyroidectomy for unilateral disease. Nodules larger than 6 cm, substernal goiter, patients with previous neck surgery, malignancy, and Graves’ disease were excluded. All patients underwent ultrasound evaluation of the thyroid and breast. In our approach (Unilateral Axillary Breast Approach), the 10-mm camera port was placed via the anterior axillary fold with two working 5 mm ports via the ipsilateral shoulder and circumareolar region. Results: Mean operating time was 133 minutes (85–180), with a mean blood loss of 40 mL (25–75). There were no conversions or major complications. One patient experienced transient voice change with complete recovery in 3 weeks. Two patients had chest wall seromas. Pain scores on the visual analog scale at recovery, 6 hours, and on the first postoperative day were 2, 1.8, and 2.3 (range 1–5, 1–3, and 1–4), respectively. The mean length of stay was 2.2 days. Seventy-seven percent (10/13) of patients rated cosmetic results and overall satisfaction as excellent (good—2, unsatisfactory—1). Port insertion and flap raising times showed statistically significant improvements in the second half of the series (p < 0.01). Conclusion: In selected patients, SET offers distinct cosmetic advantages and patient satisfaction with acceptable morbidity rates. It is a useful technique that a thyroid surgeon needs to have in his armamentarium in pursuit of patient-centered treatment goals. This study was performed during the inception of learning and thus is significant in terms of outcomes expected during the early learning curve of this procedure.

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