Operation Skill for Endoscopic Thyroidectomy Via Chest-Breast Approach_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

SU Lei , SANG Jianfeng , YAO Yongzhong ,  WANG Xuechen

Department of General Surgery， Affiliated Drum Tower Hospital of Nanjing University Medical School， Nanjing 210008， Jiangsu Province， China;

Corresponding author：

WANG Xuechen, Email: wxcglyy@sina.com

Keywords：

Chest-breast approach; Endoscopy; Thyroidectomy; Surgery

Video：

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Objective 　To explore the feasibility and safety of endoscopic thyroidectomy via chest-breast approach
and summarize the operation skill.
Method 　The clinical data of 40 cases performed endoscopic thyroidectomy via chest-breast approach from August 2010 to August 2012 in this hospital were analyzed retrospectively.
Results　 The endoscopic thyroidectomies via chest-breast approach were successfully performed in all 40 patients without conversion to open surgery， massive haemorrhage， hypercapnia， severe subcutaneous emphysema， cutaneous necrosis on chest，permanent impairment of recurrent laryngeal nerve， and permanent hypoparathyroidism. One case of hoarseness was found on 2d after operation， who returned to normal after symptomatic treatment. One case of numbness in the extremities
happened on day 2 after operation and the symptom was relieved through intravenous and oral administration of calcium treatment in 3d. One case of cutaneous tightness on chest happened， and it was spontaneous remission in a month. The operation time was （102±28.4） min （55-182 min）， intraoperative bleeding was （46±16.6） mL （30-106 mL）， and the drainage tube was removed postoperative 2-7d with an average （4±2.2） d， the postoperative hospitalization was 3-8 d with an average （4±1.1） d. All of the cases were followed-up after operation without low calcium， low parathyroid hormone， hoarseness， and local goiter recurrence. Two cases of hypoparathyroidism returned to normal after oral thyroxine dose adjustment. All the patients were satisfied with the cosmetic results.
Conclusions 　The endoscopic thyroidectomy via chest-breast approach is safe and feasible with good cosmetic results. The subcutaneous Y tunnel， the “upper yellow middle white lower red” appearance on the chest， and the landmark of inverse trapezium on the neck are the key points for creation of operation compartment. Sufficient exposure， stepwise procedure， blunt dissection combined with sharp dissection in the precise gap are the surgical skills for endoscopic thyroidectomy.

Citation： SU Lei,SANG Jianfeng,YAO Yongzhong,WANG Xuechen. Operation Skill for Endoscopic Thyroidectomy Via Chest-Breast Approach. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2013, 20(5): 512-516. doi: Copy

1.	Hüscher CS， Chiodini S， Napolitano C， et al. Endoscopic right thyroid lobectomy[J]. Surg Endosc， 1997， 11(8)：877.
2.	Tan CT， Cheah WK， Delbridge L. “Scarless” (in the neck) endoscopic thyroidectomy (SET)：an evidence-based review of published techniques[J]. World J Surg， 2008， 32(7)：1349-1357.
3.	杨映弘，蔺原，吴艳军，等. 经乳房途径腔镜甲状腺切除术27例报告[J]. 中国普外基础与临床杂志， 2005， 12(3)：299-300.
4.	何耀铭，许杰艺，卢雄伟. 经胸乳入路腔镜下甲状腺手术28例[J]. 中国医学工程， 2012， 20(2)：55， 57.
5.	关强，王贵民，王宏升. 胸骨前径路与改良Miccoli腔镜甲状腺手术临床研究[J]. 中国普外基础与临床杂志， 2010， 17(3)：240-242.
6.	Youben F， Bomin G， Bo W， et al. Trans-areola single-incision endoscopic thyroidectomy[J]. Surg Laparosc Endosc Percutan Tech， 2011， 21(4)：e192-e196.
7.	赵霞，张能维，朱斌，等. 经胸乳入路腔镜与开放手术治疗甲状腺良性肿瘤对比研究[J]. 中国实用外科杂志， 2011， 31(5)：423-425.
8.	Hong HJ， Kim WS， Koh YW， et al. Endoscopic thyroidectomy via an axillo-breast approach without gas insufflation for benign thyroid nodules and micropapillary carcinomas：preliminary results[J]. Yonsei Med J， 2011，52(4)：643-654.
9.	Lu JH， Materazzi G， Miccoli M， et al. Minimally invasive video assisted thyroidectomy versus endoscopic thyroidectomy via the areola approach：a retrospective analysis of safety， postoperative recovery， and patient satisfaction[J]. Minerva Chir， 2012， 67(1)：31-37.
10.	胡超华，胡若男，魏俊，等. 腔镜下甲状腺良性疾病手术治疗的探讨[J]. 中华全科医学， 2010， 8(12)：1541-1542.
11.	Jeryong K， Jinsun L， Hyegyong K， et al. Total endoscopic thyroidectomy with bilateral breast areola and ipsilateral axillary (BBIA) approach[J]. World J Surg， 2008， 32(11)：2488-2493.
12.	杜果城，郭黎，任明扬，等. 局麻下经胸前入路腔镜甲状腺手术的体会[J]. 中国普外基础与临床杂志， 2010， 17(8)：783-784.
13.	Papaspyrou G， Ferlito A， Silver CE， et al. Extracervical approa-ches to endoscopic thyroid surgery[J]. Surg Endosc， 2011， 25(4)：995-1003.
14.	靳小建，卢榜裕，蔡小勇，等. 腔镜乳晕径路甲状腺良性肿瘤手术的学习曲线[J]. 腹腔镜外科杂志， 2009， 14(3)：174-176.
15.	Slotema ET， Sebag F， Henry JF. What is the evidence for endoscopic thyroidectomy in the management of benign thyroid disease?[J]. World J Surg， 2008， 32(7)：1325-1332.
16.	Chang EH， Lobe TE， Wright SK. Our initial experience of the transaxillary totally endoscopic approach for hemithyroidectomy[J]. Otolaryngol Head Neck Surg， 2009， 141(3)：335-339.
17.	Lee D， Nam Y， Sung K. Single-incision endoscopic thyroidectomyby the axillary approach[J]. J Laparoendosc Adv Surg Tech A， 2010， 20(10)：839-842.
18.	Shan CX， Zhang W， Jiang DZ， et al. Prevalence， risk factors，and management of seroma formation after breast approachendoscopic thyroidectomy[J]. World J Surg， 2010， 34(8)：1817-1822.
19.	孙铁为，孙士波，吴德权. 腔镜技术在甲状腺手术中的应用及并发症的预防[J]. 中国普外基础与临床杂志， 2005， 12(6)：566-567.
20.	段君英，林宝行，高恒元. 经胸乳径路腔镜甲状腺手术180例的临床研究[J]. 中华腔镜外科杂志：电子版， 2011， 4(1)：17-20.
21.	王伟，陈德兴，董加纯. 内镜下甲状腺手术皮下隧道的制备及其并发症的防治[J]. 中国微创外科杂志， 2007， 7(11)：1079-1080.
22.	叶显道，吴伟，尹志强. 胸乳入路腔镜甲状腺手术的临床应用[J]. 安徽医学， 2009， 30(2)：160-162.
23.	Kim SJ， Lee KE， Myong JP， et al. Recovery of sensation in the anterior chest area after bilateral axillo-breast approach endoscopic/robotic thyroidectomy[J]. Surg Laparosc Endosc Percutan Tech， 2011， 21(5)：366-371.
24.	张伟耀，汤治平，丁纪伟，等. 腔镜甲状腺切除术中手术操作空间的应用体会[J]. 岭南现代临床外科， 2011， 11(4)：253-255.
25.	张金成，汤治平，梁志宏，等. 腔镜甲状腺手术拉钩的研制及临床应用[J]. 医师进修杂志， 2005， 28(20)：39-40.

1. Hüscher CS， Chiodini S， Napolitano C， et al. Endoscopic right thyroid lobectomy[J]. Surg Endosc， 1997， 11(8)：877.
2. Tan CT， Cheah WK， Delbridge L. “Scarless” (in the neck) endoscopic thyroidectomy (SET)：an evidence-based review of published techniques[J]. World J Surg， 2008， 32(7)：1349-1357.
3. 杨映弘，蔺原，吴艳军，等. 经乳房途径腔镜甲状腺切除术27例报告[J]. 中国普外基础与临床杂志， 2005， 12(3)：299-300.
4. 何耀铭，许杰艺，卢雄伟. 经胸乳入路腔镜下甲状腺手术28例[J]. 中国医学工程， 2012， 20(2)：55， 57.
5. 关强，王贵民，王宏升. 胸骨前径路与改良Miccoli腔镜甲状腺手术临床研究[J]. 中国普外基础与临床杂志， 2010， 17(3)：240-242.
6. Youben F， Bomin G， Bo W， et al. Trans-areola single-incision endoscopic thyroidectomy[J]. Surg Laparosc Endosc Percutan Tech， 2011， 21(4)：e192-e196.
7. 赵霞，张能维，朱斌，等. 经胸乳入路腔镜与开放手术治疗甲状腺良性肿瘤对比研究[J]. 中国实用外科杂志， 2011， 31(5)：423-425.
8. Hong HJ， Kim WS， Koh YW， et al. Endoscopic thyroidectomy via an axillo-breast approach without gas insufflation for benign thyroid nodules and micropapillary carcinomas：preliminary results[J]. Yonsei Med J， 2011，52(4)：643-654.
9. Lu JH， Materazzi G， Miccoli M， et al. Minimally invasive video assisted thyroidectomy versus endoscopic thyroidectomy via the areola approach：a retrospective analysis of safety， postoperative recovery， and patient satisfaction[J]. Minerva Chir， 2012， 67(1)：31-37.
10. 胡超华，胡若男，魏俊，等. 腔镜下甲状腺良性疾病手术治疗的探讨[J]. 中华全科医学， 2010， 8(12)：1541-1542.
11. Jeryong K， Jinsun L， Hyegyong K， et al. Total endoscopic thyroidectomy with bilateral breast areola and ipsilateral axillary (BBIA) approach[J]. World J Surg， 2008， 32(11)：2488-2493.
12. 杜果城，郭黎，任明扬，等. 局麻下经胸前入路腔镜甲状腺手术的体会[J]. 中国普外基础与临床杂志， 2010， 17(8)：783-784.
13. Papaspyrou G， Ferlito A， Silver CE， et al. Extracervical approa-ches to endoscopic thyroid surgery[J]. Surg Endosc， 2011， 25(4)：995-1003.
14. 靳小建，卢榜裕，蔡小勇，等. 腔镜乳晕径路甲状腺良性肿瘤手术的学习曲线[J]. 腹腔镜外科杂志， 2009， 14(3)：174-176.
15. Slotema ET， Sebag F， Henry JF. What is the evidence for endoscopic thyroidectomy in the management of benign thyroid disease?[J]. World J Surg， 2008， 32(7)：1325-1332.
16. Chang EH， Lobe TE， Wright SK. Our initial experience of the transaxillary totally endoscopic approach for hemithyroidectomy[J]. Otolaryngol Head Neck Surg， 2009， 141(3)：335-339.
17. Lee D， Nam Y， Sung K. Single-incision endoscopic thyroidectomyby the axillary approach[J]. J Laparoendosc Adv Surg Tech A， 2010， 20(10)：839-842.
18. Shan CX， Zhang W， Jiang DZ， et al. Prevalence， risk factors，and management of seroma formation after breast approachendoscopic thyroidectomy[J]. World J Surg， 2010， 34(8)：1817-1822.
19. 孙铁为，孙士波，吴德权. 腔镜技术在甲状腺手术中的应用及并发症的预防[J]. 中国普外基础与临床杂志， 2005， 12(6)：566-567.
20. 段君英，林宝行，高恒元. 经胸乳径路腔镜甲状腺手术180例的临床研究[J]. 中华腔镜外科杂志：电子版， 2011， 4(1)：17-20.
21. 王伟，陈德兴，董加纯. 内镜下甲状腺手术皮下隧道的制备及其并发症的防治[J]. 中国微创外科杂志， 2007， 7(11)：1079-1080.
22. 叶显道，吴伟，尹志强. 胸乳入路腔镜甲状腺手术的临床应用[J]. 安徽医学， 2009， 30(2)：160-162.
23. Kim SJ， Lee KE， Myong JP， et al. Recovery of sensation in the anterior chest area after bilateral axillo-breast approach endoscopic/robotic thyroidectomy[J]. Surg Laparosc Endosc Percutan Tech， 2011， 21(5)：366-371.
24. 张伟耀，汤治平，丁纪伟，等. 腔镜甲状腺切除术中手术操作空间的应用体会[J]. 岭南现代临床外科， 2011， 11(4)：253-255.
25. 张金成，汤治平，梁志宏，等. 腔镜甲状腺手术拉钩的研制及临床应用[J]. 医师进修杂志， 2005， 28(20)：39-40.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Operation Skill for Endoscopic Thyroidectomy Via Chest-Breast Approach

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