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

Department of General Surgery, Center of Thyroid, Affiliated Sixth People's Hospital, Medical School, Shanghai JiaoTong University, 600 Yishan Road, Shanghai, 200233, China.
Surgical Endoscopy (Impact Factor: 3.43). 12/2011; 26(4):939-47. DOI: 10.1007/s00464-011-1972-y
Source: PubMed

ABSTRACT 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.
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.
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.
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.

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    ABSTRACT: Abstract Objectives: To investigate the feasibility and safety of transareola single-site endoscopic thyroidectomy. Subjects and Methods: Twenty-eight patients with thyroid nodules were involved in this study. An incision was cut on a single areola, and a laparoendoscope apparatus and an operating apparatus were implanted. The thyroid gland was exposed using the neck suture suspension technique, and the damaged thyroid gland was removed with an ultrasonic scalpel. The operation time, intraoperative bleeding volume, postoperative pain score, and cosmetic satisfaction score were calculated. Results: Unilateral subtotal thyroidectomy was performed in 12 cases, unilateral partial thyroidectomy in 14 cases, and bilateral partial thyroidectomy in 2 cases. For the former 14 cases, the operation time was 145-205 minutes, with a mean duration of 170 minutes; the operation time ranged from 125 to 150 minutes, with a mean of 135 minutes, for the latter 14 cases. The intraoperative bleeding volume was 15-40 mL, with a mean of 25 mL. The total postoperative wound drainage was 80-135 mL, with a mean of 110 mL. The drainage tube was removed 3-4 days after surgery. The visual analog scale score was 1-5 at 24 hours postoperatively, with a mean score of 3.10. Postoperative pathological examination diagnosed thyroid adenoma in 11 cases and nodular goiter in 17 cases. Conclusions: Transareola single-site endoscopic thyroidectomy is feasible and safe and has the advantages of a covert incision, small subcutaneous separation area, and high cosmetic satisfaction. The operation time shortens with the increasing number of patients undergoing operations.
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    ABSTRACT: Abstract Background: Transareola single-site endoscopic thyroidectomy has been successfully established as a surgical approach. This study investigated the feasibility and safety of transareola single-site endoscopic thyroidectomy for bilateral thyroid disease. Patients and Methods: Twelve patients who underwent bilateral thyroidectomy were enrolled in this study. The surgical outcomes were analyzed, including operation time, intraoperative bleeding volume, postoperative pain score, and cosmetic satisfaction score. Results: All patients underwent successful transareola single-site endoscopic bilateral thyroidectomy, and no patient was semiconverted to three-port endoscopic surgery or open surgery. Seven patients underwent bilateral partial thyroidectomy, and 5 patients underwent subtotal thyroidectomy plus contralateral partial thyroidectomy. The mean operation time was 165±23.8 minutes (range, 142-185 minutes). The mean intraoperative bleeding volume was 27.3±12.3 mL (range, 20-45 mL). The mean postoperative wound drainage was 121±45.8 mL (range, 85-137 mL). The drainage tube was removed 3-4 days after surgery. The mean visual analog scale score was 3.3±2.5 (range, 1-5) at 24 hours postoperatively. The patients were followed up for 2 month with no complaint of chest wall wound pain and numbness. The mean cosmetic satisfaction score was 9.55±0.8 (range, 8-10). Conclusions: Transareola single-site endoscopic bilateral thyroidectomy is feasible and safe and has the advantages of high cosmetic satisfaction.
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    ABSTRACT: BACKGROUND: Based on our experience of trans-areola single-site endoscopic thyroidectomy and a preclinical study in the porcine model, we attempted to develop a new approach called trans-submental single-port endoscopic thyroidectomy (TSSPET). METHODS: Two female patients (43 and 27 years old, respectively) were selected for TSSPET. Both were preoperatively diagnosed with benign thyroid nodule by ultrasonography and fine-needle aspiration cytology (FNAC). Two mini-incisions were made in the submental area. The isthmectomy was performed for 1 patient and a right lobectomy for the other. RESULTS: This procedure was successfully accomplished in 2 cases. The operative time was 108 minutes and 150 minutes, respectively. No complications occurred. Postoperative hospital stay was 2 days. After 3 months, cosmetic result was satisfactory. CONCLUSION: Our initial experience demonstrates that the TSSPET is feasible and safe for selected patients. Nevertheless, large series and comparative studies could be necessary to further confirm its effectiveness. © 2013 Wiley Periodicals, Inc. Head Neck, 2013.
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