Endoscopic thyroid lobectomy using bilateral axillo-breast approach: Surgical techniques and outcomes

Aim: The aim of the present study was to report our surgical technique and perioperative outcomes of endoscopic thyroid lobectomy using the bilateral axillo-breast approach (BABA). Patients and Methods: We conducted a retrospective cohort analysis of prospectively-collected data on consecutive female patients who underwent BABA endoscopic unilateral thyroid lobectomy for indeterminate thyroid nodules. Results: Between July 2012 and July 2014, 18 patients with a mean age of 37.9 +/- 14.4 years received BABA endoscopic right (n = 12) and left (n = 6) thyroid lobectomy for nodules with atypia of undetermined significance (n = 7), follicular lesion of undetermined significance (n = 6) and follicular neoplasm (n = 5) in our unit. The mean nodule size was 23.6 +/- 9.7 mm. All operations were successfully accomplished with no conversion to open procedures. The mean operating time was 155.9 +/- 34.9 min. Intraoperative blood loss was negligible in all patients (below 10 mL). There was no postoperative haemorrhage, wound hematoma or iatrogenic parathyroid injury. Transient recurrent laryngeal nerve palsy occurred in one patient (5.6 per cent), whose condition completely recovered after 6 months. The mean hospital stay was 2.5 +/- 0.7 days. At 6 months after surgery, the mean cosmetic satisfaction score was 94.4 +/- 12.4 out of 100. Chronic anterior chest wall pain and chest wall paresthesia was only reported in one respective patient (5.6 per cent). Conclusion: BABA is a feasible and cosmetically-excellent technique in performing endoscopic thyroid lobectomy. It should be recommended for eligible patients who have strong desire on cosmetic outcomes.