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Erschienen in: Surgical Endoscopy 4/2012

01.04.2012

Trans-areola single-site endoscopic thyroidectomy: pilot study of 35 cases

Erschienen in: Surgical Endoscopy | Ausgabe 4/2012

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Abstract

Background

Endoscopic thyroidectomy via thoracic/breast approach is an acceptable and successful technique in Asia. This technique has the advantage of better cosmesis compared with open or even video-assisted thyroidectomy. Unfortunately, because of the need for three separate ports, conventional endoscopic thyroidectomy usually involves significantly more tissue dissection, and thus more injury to patients, limiting the popularity of this technique. We herein present 35 cases of trans-areola single-site endoscopic thyroidectomy (TASSET), which was first performed in 2009.

Methods

Thirty-five patients who underwent TASSET for thyroid nodules from September 2009 to March 2011 were evaluated. The surgical outcomes of the surgery were retrospectively analyzed, including conversion, operative time, estimated blood loss, complications, length of stay, and patient satisfaction.

Results

Thirty-one of the 35 patients (88.5%) underwent successful TASSET, with subtotal lobectomy being the most common procedure. Median operative time for the surgery was 153.65 min (range 100–190 min). Estimated blood loss ranged from 20 to 40 mL. Length of postoperative stay ranged from 2 to 4 days (average 2.5 days). Visual analog scale scores were 0 to 4 without administration of analgesics. The complication rate was low (8.6%) and included one case of transient recurrent laryngeal nerve (RLN) palsy, one case of subcutaneous seroma, and one case of tracheal injury. All patients were satisfied with the cosmetic outcome after mean follow-up of 8 months.

Conclusions

TASSET is feasible and safe, with great cosmetic benefits and less injury than other procedures. It may become an alternative procedure for treatment of patients with benign thyroid tumors, especially those with strong desire for cervical cosmesis.
Literatur
1.
Zurück zum Zitat Tan CT, Cheah WK, Delbridge L (2008) “Scarless” (in the neck) endoscopic thyroidectomy (SET): an evidence-based review of published techniques. World J Surg 32:1349–1357PubMedCrossRef Tan CT, Cheah WK, Delbridge L (2008) “Scarless” (in the neck) endoscopic thyroidectomy (SET): an evidence-based review of published techniques. World J Surg 32:1349–1357PubMedCrossRef
2.
Zurück zum Zitat Lee D, Nam Y, Sung K (2010) Single-incision endoscopic thyroidectomy by the axillary approach. J Laparoendosc Adv Surg Tech A 20:839–842PubMedCrossRef Lee D, Nam Y, Sung K (2010) Single-incision endoscopic thyroidectomy by the axillary approach. J Laparoendosc Adv Surg Tech A 20:839–842PubMedCrossRef
3.
Zurück zum Zitat Miccoli P, Pinchera A, Cecchini G, Conte M, Bendinelli C, Vignali E, Picone A, Marcocci C (1997) Minimally invasive, video-assisted parathyroid surgery for primary hyperparathyroidism. J Endocrinol Invest 20:429–430PubMed Miccoli P, Pinchera A, Cecchini G, Conte M, Bendinelli C, Vignali E, Picone A, Marcocci C (1997) Minimally invasive, video-assisted parathyroid surgery for primary hyperparathyroidism. J Endocrinol Invest 20:429–430PubMed
4.
Zurück zum Zitat Gagner M (1996) Endoscopic subtotal parathyroidectomy in patients with primary hyperparathyroidism. Br J Surg 83:875PubMedCrossRef Gagner M (1996) Endoscopic subtotal parathyroidectomy in patients with primary hyperparathyroidism. Br J Surg 83:875PubMedCrossRef
5.
Zurück zum Zitat Hüscher CS, Chiodini S, Napolitano C, Recher A (1997) Endoscopic right thyroid lobectomy. Surg Endosc 11:877PubMedCrossRef Hüscher CS, Chiodini S, Napolitano C, Recher A (1997) Endoscopic right thyroid lobectomy. Surg Endosc 11:877PubMedCrossRef
6.
Zurück zum Zitat Ikeda Y, Takami H, Sasaki Y, Kan S, Niimi M (2000) Endoscopic resection of thyroid tumors by the axillary approach. J Cardiovasc Surg (Torino) 41:791–792 Ikeda Y, Takami H, Sasaki Y, Kan S, Niimi M (2000) Endoscopic resection of thyroid tumors by the axillary approach. J Cardiovasc Surg (Torino) 41:791–792
7.
Zurück zum Zitat 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 10:1–4PubMed 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 10:1–4PubMed
8.
Zurück zum Zitat Kataoka H, Kitano H, Takeuchi E, Fujimura M (2002) Total video endoscopic thyroidectomy via the anterior chest approach using the cervical region-lifting method. Biomed Pharmacother 56:68s–71sPubMedCrossRef Kataoka H, Kitano H, Takeuchi E, Fujimura M (2002) Total video endoscopic thyroidectomy via the anterior chest approach using the cervical region-lifting method. Biomed Pharmacother 56:68s–71sPubMedCrossRef
9.
Zurück zum Zitat Schardey HM, Schopf S, Kammal M, Barone M, Rudert W, Hernandez-Richter T, Pörtl S (2008) Invisible scar endoscopic thyroidectomy by the dorsal approach: experimental development of a new technique with human cadavers and preliminary clinical results. Surg Endosc 22:813–820PubMedCrossRef Schardey HM, Schopf S, Kammal M, Barone M, Rudert W, Hernandez-Richter T, Pörtl S (2008) Invisible scar endoscopic thyroidectomy by the dorsal approach: experimental development of a new technique with human cadavers and preliminary clinical results. Surg Endosc 22:813–820PubMedCrossRef
10.
Zurück zum Zitat Schardey HM, Barone M, Pörtl S, von Ahnen M, von Ahnen T, Schopf S (2010) Invisible scar endoscopic dorsal approach thyroidectomy: a clinical feasibility study. World J Surg 34:2997–3006PubMedCrossRef Schardey HM, Barone M, Pörtl S, von Ahnen M, von Ahnen T, Schopf S (2010) Invisible scar endoscopic dorsal approach thyroidectomy: a clinical feasibility study. World J Surg 34:2997–3006PubMedCrossRef
11.
Zurück zum Zitat Ikeda Y, Takami H, Sasaki Y, Takayama J, Niimi M, Kan S (2002) Comparative study of thyroidectomies. Endoscopic surgery versus conventional open surgery. Surg Endosc 16:1741–1745PubMedCrossRef Ikeda Y, Takami H, Sasaki Y, Takayama J, Niimi M, Kan S (2002) Comparative study of thyroidectomies. Endoscopic surgery versus conventional open surgery. Surg Endosc 16:1741–1745PubMedCrossRef
12.
Zurück zum Zitat Duh QY (2003) Presidential address: minimally invasive endocrine surgery–standard of treatment or hype? Surgery 134:849–857PubMedCrossRef Duh QY (2003) Presidential address: minimally invasive endocrine surgery–standard of treatment or hype? Surgery 134:849–857PubMedCrossRef
13.
14.
Zurück zum Zitat Piskun G, Rajpal S (1999) Transumbilical laparoscopic cholecystectomy utilizes no incisions outside the umbilicus. J Laparoendosc Adv Surg Tech A 9:361–364PubMedCrossRef Piskun G, Rajpal S (1999) Transumbilical laparoscopic cholecystectomy utilizes no incisions outside the umbilicus. J Laparoendosc Adv Surg Tech A 9:361–364PubMedCrossRef
15.
Zurück zum Zitat Nguyen NT, Hinojosa MW, Smith BR, Reavis KM (2008) Single laparoscopic incision transabdominal (SLIT) surgery-adjustable gastric banding: a novel minimally invasive surgical approach. Obes Surg 18:1628–1631PubMedCrossRef Nguyen NT, Hinojosa MW, Smith BR, Reavis KM (2008) Single laparoscopic incision transabdominal (SLIT) surgery-adjustable gastric banding: a novel minimally invasive surgical approach. Obes Surg 18:1628–1631PubMedCrossRef
16.
Zurück zum Zitat Oltmann SC, Rivas H, Varela E, Goova MT, Scott DJ (2009) Single-incision laparoscopic surgery: case report of SILS adjustable gastric banding. Surg Obes Relat Dis 5:362–364PubMedCrossRef Oltmann SC, Rivas H, Varela E, Goova MT, Scott DJ (2009) Single-incision laparoscopic surgery: case report of SILS adjustable gastric banding. Surg Obes Relat Dis 5:362–364PubMedCrossRef
17.
Zurück zum Zitat Gill IS, Advincula AP, Aron M, Caddedu J, Canes D, Curcillo PG 2nd, Desai MM, Evanko JC, Falcone T, Fazio V, Gettman M, Gumbs AA, Haber GP, Kaouk JH, Kim F, King SA, Ponsky J, Remzi F, Rivas H, Rosemurgy A, Ross S, Schauer P, Sotelo R, Speranza J, Sweeney J, Teixeira J (2010) Consensus statement of the consortium for laparoendoscopic single-site surgery. Surg Endosc 24:762–768PubMedCrossRef Gill IS, Advincula AP, Aron M, Caddedu J, Canes D, Curcillo PG 2nd, Desai MM, Evanko JC, Falcone T, Fazio V, Gettman M, Gumbs AA, Haber GP, Kaouk JH, Kim F, King SA, Ponsky J, Remzi F, Rivas H, Rosemurgy A, Ross S, Schauer P, Sotelo R, Speranza J, Sweeney J, Teixeira J (2010) Consensus statement of the consortium for laparoendoscopic single-site surgery. Surg Endosc 24:762–768PubMedCrossRef
18.
Zurück zum Zitat Wewers ME, Lowe NK (1990) A critical review of visual analogue scales in the measurement of clinical phenomena. Res Nurs Health 13:227–236PubMedCrossRef Wewers ME, Lowe NK (1990) A critical review of visual analogue scales in the measurement of clinical phenomena. Res Nurs Health 13:227–236PubMedCrossRef
19.
Zurück zum Zitat De Carlucci D Jr, Tavares MR, Obara MT, Martins LA, Hojaij FC, Cernea CR (2008) Thyroid function after unilateral total lobectomy: risk factors for postoperative hypothyroidism. Arch Otolaryngol Head Neck Surg 134:1076–1079PubMedCrossRef De Carlucci D Jr, Tavares MR, Obara MT, Martins LA, Hojaij FC, Cernea CR (2008) Thyroid function after unilateral total lobectomy: risk factors for postoperative hypothyroidism. Arch Otolaryngol Head Neck Surg 134:1076–1079PubMedCrossRef
20.
Zurück zum Zitat Yoon JH, Park CH, Chung WY (2006) Gasless endoscopic thyroidectomy via an axillary approach: experience of 30 cases. Surg Laparosc Endosc Percutan Tech 16:226–231PubMedCrossRef Yoon JH, Park CH, Chung WY (2006) Gasless endoscopic thyroidectomy via an axillary approach: experience of 30 cases. Surg Laparosc Endosc Percutan Tech 16:226–231PubMedCrossRef
21.
Zurück zum Zitat Dutta S (2009) Early experience with single incision laparoscopic surgery: eliminating the scar from abdominal operations. J Pediatr Surg 44:1741–1745PubMedCrossRef Dutta S (2009) Early experience with single incision laparoscopic surgery: eliminating the scar from abdominal operations. J Pediatr Surg 44:1741–1745PubMedCrossRef
22.
Zurück zum Zitat Li Z, Wang P, Wang Y, Xu S, Cao L, Que R, Zhou F (2011) Endoscopic lateral neck dissection via breast approach for papillary thyroid carcinoma: a preliminary report. Surg Endosc 25:890–896PubMedCrossRef Li Z, Wang P, Wang Y, Xu S, Cao L, Que R, Zhou F (2011) Endoscopic lateral neck dissection via breast approach for papillary thyroid carcinoma: a preliminary report. Surg Endosc 25:890–896PubMedCrossRef
23.
Zurück zum Zitat Podolsky ER, Mouhlas A, Wu AS, Poor AE, Curcillo PG 2nd (2010) Single Port Access (SPA) laparoscopic ventral hernia repair: initial report of 30 cases. Surg Endosc 24:1557–1761PubMedCrossRef Podolsky ER, Mouhlas A, Wu AS, Poor AE, Curcillo PG 2nd (2010) Single Port Access (SPA) laparoscopic ventral hernia repair: initial report of 30 cases. Surg Endosc 24:1557–1761PubMedCrossRef
24.
Zurück zum Zitat Owaki T, Nakano S, Arimura K, Aikou T (2002) The ultrasonic coagulating and cutting system injures nerve function. Endoscopy 34:575–579PubMedCrossRef Owaki T, Nakano S, Arimura K, Aikou T (2002) The ultrasonic coagulating and cutting system injures nerve function. Endoscopy 34:575–579PubMedCrossRef
25.
Zurück zum Zitat Ikeda Y, Takami H, Sasaki Y, Takayama J, Niimi M, Kan S (2003) Clinical benefits in endoscopic thyroidectomy by the axillary approach. J Am Coll Surg 196:189–195PubMedCrossRef Ikeda Y, Takami H, Sasaki Y, Takayama J, Niimi M, Kan S (2003) Clinical benefits in endoscopic thyroidectomy by the axillary approach. J Am Coll Surg 196:189–195PubMedCrossRef
26.
Zurück zum Zitat Shan CX, Zhang W, Jiang DZ, Zheng XM, Liu S, Qiu M (2010) Prevalence, risk factors, and management of seroma formation after breast approach endoscopic thyroidectomy. World J Surg 34:1817–1822PubMedCrossRef Shan CX, Zhang W, Jiang DZ, Zheng XM, Liu S, Qiu M (2010) Prevalence, risk factors, and management of seroma formation after breast approach endoscopic thyroidectomy. World J Surg 34:1817–1822PubMedCrossRef
27.
Zurück zum Zitat Park YL, Han WK, Bae WG (2003) 100 cases of endoscopic thyroidectomy: breast approach. Surg Laparosc Endosc Percutan Tech 13:20–25PubMedCrossRef Park YL, Han WK, Bae WG (2003) 100 cases of endoscopic thyroidectomy: breast approach. Surg Laparosc Endosc Percutan Tech 13:20–25PubMedCrossRef
28.
Zurück zum Zitat Fan Y, Guo B, Guo S, Kang J, Wu B, Zhang P, Zheng Q (2010) Minimally invasive video-assisted thyroidectomy: experience of 300 cases. Surg Endosc 24:2393–2400PubMedCrossRef Fan Y, Guo B, Guo S, Kang J, Wu B, Zhang P, Zheng Q (2010) Minimally invasive video-assisted thyroidectomy: experience of 300 cases. Surg Endosc 24:2393–2400PubMedCrossRef
29.
Zurück zum Zitat 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 23:1802–1806PubMedCrossRef 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 23:1802–1806PubMedCrossRef
30.
Zurück zum Zitat Connor S (2009) Single-port-access cholecystectomy: history should not be allowed to repeat. World J Surg 33:1020–1021PubMedCrossRef Connor S (2009) Single-port-access cholecystectomy: history should not be allowed to repeat. World J Surg 33:1020–1021PubMedCrossRef
31.
Zurück zum Zitat Tae K, Ji YB, Jeong JH, Lee SH, Jeong MA, Park CW (2011) Robotic thyroidectomy by a gasless unilateral axillo-breast or axillary approach: our early experiences. Surg Endosc 25:221–228PubMedCrossRef Tae K, Ji YB, Jeong JH, Lee SH, Jeong MA, Park CW (2011) Robotic thyroidectomy by a gasless unilateral axillo-breast or axillary approach: our early experiences. Surg Endosc 25:221–228PubMedCrossRef
32.
Zurück zum Zitat Papaspyrou G, Ferlito A, Silver CE, Werner JA, Genden E, Sesterhenn AM (2011) Extracervical approaches to endoscopic thyroid surgery. Surg Endosc 25(4):995–1003PubMedCrossRef Papaspyrou G, Ferlito A, Silver CE, Werner JA, Genden E, Sesterhenn AM (2011) Extracervical approaches to endoscopic thyroid surgery. Surg Endosc 25(4):995–1003PubMedCrossRef
Metadaten
Titel
Trans-areola single-site endoscopic thyroidectomy: pilot study of 35 cases
Publikationsdatum
01.04.2012
Erschienen in
Surgical Endoscopy / Ausgabe 4/2012
Print ISSN: 0930-2794
Elektronische ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-011-1972-y

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