Choi Y, et al. Ann Dermatol. 2014 Dec;26(6):693-699. http://dx.doi.org/10.5021/ad.2014.26.6.693

Purpose: During the past decade, various techniques of endoscopic thyroid surgery have been introduced. We have developed a novel method of gasless endoscopic thyroidectomy via an axillary approach. The present report describes the technique of this method, and analyzes its surgical outcome. Patients and Methods: Between Nov. 2001 and Dec. 2007 (actual operation period was 50 months), 581 patients with thyroid tumors underwent gasless endoscopic thyroidectomy via an axillary approach. The clinical and pathologic characteristics of patients, operation type, operation time, post operative hospital stay and post operative complications were analyzed retrospectively. Results: Among the 581 patients, 171 patients had benign tumor and 410 patients had malignant tumor. There was no conversion to open surgery. The operating time and the length of post-operative hospital stay were 129.4±51.3 minutes, 3.3±1.7 days in benign tumor, and 135.5±47 minutes, 3.4±0.9 days in malignant tumors, respectively. The tumor size was 2.7±1.2 cm in benign tumor and 0.78±0.5 cm in malignancy. Central compartment lymph node metastasis was found in 112 (27.3%) patients and lateral neck lymph node metastasis in 13 (3.1%) patients. As post-operative complications, transient hypocalcemia occurred in 19 patients and transient hoarseness was in 13 patients and permanent vocal cord palsy occurred in 2 patients. In the TNM stage, 366 (89.2%) patients were stage I, 43 (10.5%) patients were stage III and 1 (0.2%) patient was stage IVA. Conclusion: According to our experience, gasless endoscopic thyroidectomy using a trans-axillary approach is a feasible and safe method. Endoscopic thyroid surgery has become a new treatment modality for the patients with benign tumors and can be an effective alternative treatment for the selected patients with thyroid cancer.

Lee YS, et al. J Korean Med Sci. 2010 Apr;25(4):541-545. http://dx.doi.org/10.3346/jkms.2010.25.4.541

Background: The aim of this study was to evaluate and compare the early surgical outcomes of endoscopic and conventional open thyroidectomies in patients with papillary thyroid microcarcinoma (PTMC).Methods: Between September 2005 and December 2007, 499 patients with PTMC were enrolled. 275 patients underwent gasless endoscopic thyroidectomy via the axillary route (endo group), and 224 patients underwent conventional open thyroidectomy (open group). We analyzed the patient's clinico‐pathologic characteristics and surgical completeness between the two groups.Results: The endo group was younger than the open group. The open group underwent more extensive surgery than the endo group. The operative time was longer in the endo group than the open group (138.5 ± 49.0 min vs. 105.5 ± 41.6 min; P < 0.0001), and a lesser number of lymph nodes were retrieved in the endo group compared to the open group (5.05 ± 2.94 vs. 5.96 ± 4.50, P = 0.007). We experienced complications in the endo group, such as transient hypocalcemia, transient RLN palsies, tracheal injuries, and esophageal injuries. There was no abnormal uptake on RAI scans in the two groups. From among patients who had undergone total thyroidectomy, all patients in the endo group had 1 ng/ml of serum Tg post‐operatively. Tumor recurrence was detected in the open group only (n = 6). Also we checked the post‐operative Tg in patients who had undergone lobectomy in the two groups, and found that there were no statistical differences in the two groups.Conclusions: According to our experience, gasless endoscopic thyroidectomy using a trans‐axillary approach is a safe and feasible alternative to conventional open thyroidectomy in selected patients with PTMC. J. Surg. Oncol. 2009;100:477–480.