| Endoscoic thyroidectomy is a safe and effective method that gives good surgical completeness, minimal invasion, quick recovery and an excellent cosmetic result. Therefore,This method is a good choice for patients with surgical thyroid diseases.Since the first reported endoscopic parathyroidectomy for hyperparathyroidism in1996, various endoscopic techniques have been applied to benign thyroid diseases including those that involve access via breast, anterior chest wall, axilla, breast-axilla,single-port,and trans-oral.which had advantages and disadvantaes separately.Endoscopic thyroidectomy by the breast approach is a populary surgery now, but there was usually a scar in the chest wall, which induced discomfortable and bad cosmetic result.there were some measures to improve this disadvantages,but the result were not ideal. However, ideal approch of endoscopic thyroidectomy should be safe, simple maniplation, less postoperative complications minimal invasion, quick recovery, an excellent cosmetic result and easy spread. So it is necessary to explore a ideal approch of endoscopic thyroidectomy. For this reasion,Trans-axillary single-port endoscopic thyroidectomy (TASPET) and endoscopic thyroidectomy via bilateral breast and ipsilateral axillary approach(BBIAA) had been developed,The aims of this study are to analyze their surgical outcomes and to evaluate the effectiveness and safety,the results of two approchs were made a systematic comparative analysis. Part I Total endoscopic thyroidectomy via bilateral breast and ipsilateral axillary approach(BBIAA):a clinical feasibility studyObjective To explore the feasibility and safety of totalendoscopic thyroidectomy via bilateral breast and ipsilateral axillary approach(BBIAA), and evaluate the outcomes of this procedure.Methods Between May2011and august2012,34patients with thyroid diseases underwent endoscopic thyroidectomy via BBIAA.The patients clinical data,operative time,blood loss,drainage amounts,complications, hospital stay,area of skin flap,postoperative visualanalog pain score(VAPS) were analyzed retrospectively. We describe here the details of our operative technique.Results Of34patients,33were diagnosed with benign thyroid disease by pathologic diagnosis.1patient were diagnosed with early thyroid papillary carcinoma,The patient returned to the operating room to have a complete endoscopic radical thyroidectomy via the breast approach.34patients successfully underwent endoscopic thyroidectomy. No postoperative complications,Mean Operation time was104±25.3min. Mean blood loss was10.5±3.69ml. The average area of skin flap was78.6±8.64cm2. Mean postoperative drainage amounts on day1were84.5±62.56ml. The average hospital stay after opearation was3to4days. The postoperative VAS on day1were0-2. Follow-up visits range from2to12months suggested that no one had relapse. Furthermore, the patients were uniformly pleased with the cosmetic results of the operation.Conclusions Endoscopic thyroidectomy via BBIAA is a safe and effective method that gives good surgical completeness, minimal invasion, quick recovery,simple maniplation,less postoperative complications and an excellent cosmetic result. Therefore,This method is a good choice for patients with surgical thyroid diseases.Part Ⅱ Total trans-axillary single-port endoscopic thyroidectomy: a clinical feasibility studyObjective To explore the feasibility and safety of trans-axillary single-port endoscopic thyroidectomy(TASPET), and evaluate the outcomes of this procedure.Methods Between April2011and October2012,53patients with thyroid diseases underwent TASPET.The patients clinical data,operative time,blood loss,drainage amounts,complications,hospital stay,postoperative visualanalog pain score(VAPS) were analyzed retrospectively. We describe here the details of our operative technique.Results Of53patients,51were diagnosed with benign thyroid disease by pathologic diagnosis.2patients were diagnosed with early thyroid papillary carcinoma, The2patients returned to the operating room to have a complete endoscopic radical thyroidectomy via the breast approach. Of the53patients,52patients successfully underwent endoscopic thyroidectomy. One case were subjected to open thyroidectomy due to uncontrolled bleeding.Mean Operation time was124.6±32.98min (70-195min). Mean blood loss was24.8±42.29ml(5-200ml). The mean area of skin flap was147.85±9.32cm2(128-170cm2). Mean postoperative drainage amounts on day1were103.33±69.02ml(10-270ml). The mean hospital stay after opearation was3to4days. The postoperative VAS were2.29±1.7(0-7).Regarding postoperative complications, postoperative incision infection occurred in7%of patients,transient hypocalcemia occurred in3.8%of patients and no permanent hypoparathyroidism occurred.,Chest skin numbness occurred in15%of patients, nerve injury occurred in7.6%of patiets,included3patients experienced injury of recurrent nerve and1patient experienced injury of superior laryngeal nerve. No permanent neurological damage. Follow-up visits range from4to20months suggested that no one had relapse. Furthermore, the patients were uniformly pleased with the cosmetic results of the operation.Conclusions TASPET is a safe and effective method that gives good surgical completeness, minimal invasion, quick recovery and an excellent cosmetic result. Therefore,This method is a choice for patients with surgical thyroid diseases.Part Ⅲ Endoscopic thyroidectomy by BBAET, BBIAA and TASPET: a prospective studyObjective To compare the clinical efficency of endoscopic thyroidectomy via BBIAA BBAET and TASPET in a prospective study, and to explore the rational approch.Methods Between August2010and August2012, ninety patients were underwent endoscopic thyroidectomy:20cases were underwent BBIAA (group BBIAA),42patients were underwent (TASPET)(group TASPET)and28cases were underwent (BBAET). Operative time, blood loss,the volume of drainage,time of postoperative stay, postoperative complications,postoperative visualanalog score(VAPS) and the level of postoperative CRP were compared among three groups. Each indexes were made rank correlation analysis. Results There were no significantly differences in old, operation time, volume of blood loss,the diameterof thyroid tumer, time of postoperation stay and postoperative drainage amounts on day1. There were no significantly of every indexes between group BBIAA and group BBAET. Mean blood loss of during operation was significantly less in group BBAET(12.3±4.1ml) than in group TASPET (23.69±42.54ml)(P=0.03),Mean Operation time was no significantly between group BBAET and group TASPET, The mean area of skin flap in group TASPET were more than that in group open (150.57±10.639cm2vs84.1±1.346cm2)(p<0.05), postoperative visualanalog score(VAS) and the level of postoperative CRP was less in group BBAET than that in group TASPET.there was1case postoperative complications in group BBAET.however,there were12cases in group TASPET, included2cases of postoperative incision infection,1cases of transient hypocalcemia, and no permanent hypoparathyroidism occurred.,6cases of Chest skin numbness,3cases of nerve injury,included2patients experienced injury of recurrent nerve and1patient experienced injury of superior laryngeal nerve. No permanent neurological damage.There were no significantly differences in blood loss, time of postoperation stay and postoperative drainage amounts on day1between group BBIAA and group TASPET. Mean Operation time was significantly less in group BBIAA(102.5±29.15min) than in group TASPET (128.07±41.7min)(P <0.05),The mean area of skin flap in group TASPET were more than that in group open (150.57±10.639cm2vs85±7.56cm2)(p=0.00)) postoperative visualanalog score(VAS) and the level of postoperative CRP was less in group BBIAA than that in group TASPET.there was no postoperative complications in group BBIAA.however,there were12cases in group TASPET, included2 cases of postoperative incision infection,1cases of transient hypocalcemia, and no permanent hypoparathyroidism occurred.,6cases of Chest skin numbness,3cases of nerve injury,included2patients experienced injury of recurrent nerve and1patient experienced injury of superior laryngeal nerve. No permanent neurological damage.The rank correlation analysis is no significantly in group BBIAA and group BBAET.but which had some significantly in group TASPET, included Operative time was positive correlation to the area of skin flap (r=0,321,p=0.038);postoperative complication was positive correlation to the volume of blood loss (r=0.309,p=0.047),the level of postoperative CRP was positive correlation to the area of skin flap (r=0,379,p=0.013).postoperative visualanalog score(VAS) was positive correlation to the level of postoperative CRP (r=0.321,p=0.038).Follow-up visits range from4to20months suggested that no one had relapse. Furthermore, the patients were uniformly pleased with the cosmetic results of the operation.Conclusion compared to the common approch of BBAET, BBIAA and TASPET are also safe and feasible for endoscopic thyroideetomy, and all with excellent cosmetic benefits.The degree of injury and postoperative complications were more serious in group TASPET,which are maybe related to the dissecting area for creating subcutaneous tunnel and the chang of field of vision. So the processing of TASPET are maybe more hard and difficulty than thats of BBIAA. |
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