Endoscopic Thyroidectomy Via Chest-breast Approach: Report Of 19 Cases

Objective: Aim of this study was to investigate the operative technique and feasibility of endoscopic thyroidectomy via chest-breast approach.Methods: We retrospectively studied 19 patients who had undergone endoscopic thyroidectomy via chest-breast approach from September 2009 to March 2010 in the gland sugery of the Second Hospital of Hebei Medical University. The clinical data of these 19 cases was retrospectively analyzed, of which multiple nodules in two leaves in 3 cases, multiple nodules in single leaf in 2 cases, solitary solid nodules in 6 cases, single mixed cystic and solid or cystic nodules in 8 cases. Primary diabetes mellitus in 1 case, systemic lupus erythematosus in 1 case. Pathology showed that 4 cases were nodular goiter; 4 cases were nodular goiter with adenoma; 2 cases were papillary thyroid carcinoma; 1 case was nodular goiter with papillary thyroid carcinoma; 1 case was Hashimoto's disease; 1 case was Hashimoto's disease with papillary thyroid carcinoma. All the operations were adopted the method of endoscopic thyroidectomy via chest-breast approach. All patients underwent a comprehensive preoperative examination to exclude the surgical contraindications. All of the patients used the general anesthesia with tracheal intubation. CO2 perfusion was to establish and maintain the space of operation.Results: 3 cases were cut one whole side lobe and partial contralateral lobe and the Isthmus; both sides lobes partially resected in 3 cases; single lobe partially resected in 3 cases. The mean time for total operation was 100-280mins, an average of 173minutes; The operation bleeding was 5ml ~ 50ml, an average of 14ml; the tubesr drainage time was 2~4 days; postoperative drainage was 30ml ~ 165ml, an average of 84ml; after 4 days to 13 days stitches were discharged, the average length of hospital stay was 6.3 days; hospitalization cost 8255.71 yuan ~ 23,131.95 yuan, the average cost was 12,073.79 yuan. There were no severe subcutaneous emphysema, no hoarseness, low blunt voice and drinking cough occurred postoperatively, no dyspnea, no mouths and limbs numbness, convulsions and other postoperative complications, and no postoperative bleeding and wound infection; one case had subcutaneous chest effusion, local skin irritation. All patients were satisfied with the operation. It had a better cosmetic result.Conclusion: The endoscopic thyroidectomy via chest-breast approach is safe, feasible. It can attain a excellent cosmetic effect.