Gasless endoscopic thyroidectomy using trans-axillary approach;our experience in Pakistan
DOI:
https://doi.org/10.48047/HM.10.2.2024.1755-1760Abstract
Objective
>> To report our initial experience with the transaxillary endoscopic hemi thyroidectomy with gasless approach in limited resources and e-learning.
Background
The concept of endoscopic neck surgery for thyroid or parathyroid gland started with Gainer in 1996, where the first case of parathyroidectomy was performed, and after one year, hemithyroidectomy was performed by Hushner. After that, the concept of minimally invasive neck surgeries, especially thyroid and parathyroid glands, has started in different endoscopic techniques.
Method
42-year-old lady with a right-sided solitary thyroid nodule underwent transaxillary endoscopic hemi thyroidectomy with a gasless approach in a trust hospital. The main outcome measures feasibility of that approach without the availability of a robot and some fancy instrument, gland and patient characteristics, operative time, cost-effectiveness,cosmesis, and complications.
Results
There was no conversion to open surgery.
Operative time is 180 minutes. estimated blood loss was 10-12 ml. patient tolerated the surgery well. discharge on the first postoperative day. no perioperative or postoperative complications. low cost as compared to other endoscopic techniques.no evidence of postoperative vocal cord palsy or paresis.
Conclusions
Our first and initial experience demonstrates that this technique is a feasible, effective, and safe method for hemi thyroidectomy for a small and benign thyroid lesion in starting, and with experience, a subtotal or total thyroidectomy can be performed. The use of this approach is very cost-effective as compared to robotic and other endoscopic techniques, and with excellent cosmesis, it improved patients' confidence and trust in minimally invasive surgery.
Downloads
References
Zheng RS, et al. Cancer incidence and mortality in China, 2022. Zhonghua
Zhong Liu Za Zhi. 2024;46:221–31. https://doi.org/10.3760/cma.j.cn112
152-20240119-00035.
Frohlich E, Wahl R. The current role of targeted therapies to induce
radioiodine uptake in thyroid cancer. Cancer Treat Rev. 2014;40:665–74.
https://doi.org/10.1016/j.ctrv.2014.01.002.
Huscher CS, Chiodini S, Napolitano C, Recher A. Endoscopic right thyroid
lobectomy. Surg Endosc. 1997;11:877. https://doi.org/10.1007/s0046
49900476.
Chen YH, Chao WP, Wang SH, Huang YT, Ng SC. Transoral endoscopic and
robotic thyroidectomy for thyroid cancer: the mid-term oncological outcome. Surg Endosc. 2023. https://doi.org/10.1007/s00464-023-10339-9.
Ma T, et al. Transoral and submental endoscopic thyroidectomy (TOaST)
for early stage papillary thyroid carcinoma: a real-world data retrospective cohort study. Surg Endosc. 2023. https://doi.org/10.1007/
s00464-023-10315-3
Ohgami M, et al. Scarless endoscopic thyroidectomy: breast approach for
better cosmesis. Surg Laparosc Endosc Percutan Tech. 2000;10:1–4.
Park YL, Han WK, Bae WG. 100 cases of endoscopic thyroidectomy: breast
approach. Surg Laparosc Endosc Percutan Tech. 2003;13:20–5. https://doi.
org/10.1097/00129689-200302000-00005.
Chung YS, et al. Endoscopic thyroidectomy for thyroid malignancies:
comparison with conventional open thyroidectomy. World J Surg.
2007;31(12):2302–6; discussion 2307–2308, https://doi.org/10.1007/
s00268-007-9117-0.
Sasaki A, et al. Endoscopic thyroidectomy by the breast approach: a
single institution’s 9-year experience. World J Surg. 2008;32:381–5. https://
doi.org/10.1007/s00268-007-9375-x.
Xu JJ, et al. Clinical application of the gasless unilateral axillary approach in endoscopic thyroid surgery. Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2020;55:913–20. https://doi.org/10.3760/cma.j.cn115330-20200 225-00126.
Downloads
Published
Issue
Section
License
Copyright (c) 2024 Author
This work is licensed under a Creative Commons Attribution 4.0 International License.
You are free to:
- Share — copy and redistribute the material in any medium or format for any purpose, even commercially.
- Adapt — remix, transform, and build upon the material for any purpose, even commercially.
- The licensor cannot revoke these freedoms as long as you follow the license terms.
Under the following terms:
- Attribution — You must give appropriate credit , provide a link to the license, and indicate if changes were made . You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.
- No additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.
Notices:
You do not have to comply with the license for elements of the material in the public domain or where your use is permitted by an applicable exception or limitation .
No warranties are given. The license may not give you all of the permissions necessary for your intended use. For example, other rights such as publicity, privacy, or moral rights may limit how you use the material.
