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: 3.26).
12/2011; 26(4):939-47. DOI: 10.1007/s00464-011-1972-y
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: To compare surgical outcomes between transareola single-site endoscopic thyroidectomy (TASSET) and minimally invasive video-assisted thyroidectomy (MIVAT).
Patients with thyroid nodules were randomized to TASSET (n = 24) or MIVAT (n = 24). Surgical outcomes and patient-rated cosmetic results, based on numerical (0 [worst], 10 [best]) and verbal (1 [poor], 4 [excellent]) response scales, were compared.
There were no significant differences between groups for age, sex, indication for operation, estimated blood loss, postoperative pain and length of postoperative stay. TASSET was associated with a significantly longer mean ± SD operative time than MIVAT (156.84 ± 41.42 vs. 66.38 ± 17.58 min), and significantly improved cosmetic results according to the numerical (9.63 ± 0.60 vs 7.90 ± 1.38) and verbal response (3.8 ± 0.5 vs 3.1 ± 0.7) scales. Postoperative complaints were comparable between the two approaches, although MIVAT involved a shorter operation time.
Patients treated with TASSET had superior cosmetic results compared with those treated with MIVAT.
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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.
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.
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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The cultural desire to avoid cervical incisions and increasing concern for cosmetic outcomes has motivated surgeons to develop alternative approaches to thyroid surgery. The Direct Drive Endoscopic System (DDES) platform combines a flexible endoscope with a pair of separately controlled articulating instruments through a single, flexible, access system. We hypothesized that the DDES platform would permit single-incision minimally invasive thyroid lobectomy without robotic assistance.
This is a single-cadaver feasibility study. A single, 2.2-cm subxyphoid incision was used for access. The platform's 55-cm flexible sheath was secured to the operating table rails and introduced into the subcutaneous space. A flexible pediatric endoscope was simultaneously introduced with 2 interchangeable 4-mm instruments. Blunt dissection and electrocautery were used to create the tunnel in the otherwise free central plane. The thyroid was dissected using a superior to inferior technique while maintaining the critical steps of traditional thyroid surgery. A Veress needle introduced through the lateral neck provided additional retraction.
The total operating time was 2.5 hours. The subcutaneous tunnel was safe and accommodated the DDES well. Visualization was adequate. Graspers, scissors, and hook cautery were used to complete the lobectomy. The ergonomics, articulation, and strength of the instrumentation were sufficient.
Subxyphoid thyroidectomy is technically possible and avoids the difficulties inherent to a transaxillary approach while still avoiding cosmetically unappealing cervical scars. Continued technological refinement will only expand the therapeutic possibilities of flexible endoscopy while minimizing the physical insult to patients and maximizing aesthetics for patients.
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