Cervical scarless endoscopic thyroidectomy:: Axillo-bilateral-breast approach (ABBA)

Background: Neck surgery is one of the latest applications of minimally invasive surgery. We applied a new technique for totally endoscopic thyroidectomy, the axillo-bilateral-breast approach (ABBA). This approach does not leave a scar on the neck. Methods: Between February 2005 and October 2005, 13 patients were treated by ABBA for uni- or multinodular goitres. Surgery is performed under general anaesthesia and in supine position. 5 mm bilateral skin incisions are made on the margin of the areola of nipple. They are used to insert and subcutaneously push forward a 20 cm long, 5 mm trocar to the jugular fossa. A further 5 mm incision is performed in the right axilla. The right breast trocar is the optical trocar. A Maryland clamp in axillary position and 5 mm harmonic scalpel via the left breast trocar permit a clear view of the further subfascial preparation. The caudal hyoidal muscles are longitudinally split along the linea alba. Using delicate blunt dissection, both thyroid lobes are exposed. After isthmus transection is performed, the upper thyroid pole is being mobilized. The upper pole vessels are isolated and divided close to the thyroid capsule. Preparation of the retrothyroidal area includes visualization of the recurrent laryngeal nerve. The resection is performed without bleeding with a harmonic scalpel. Via the axillary approach, with the incision being widened, a 20 mm trocar is inserted and advanced up to the thyroid lodge to remove the specimen. Results: The average operation time was 132 minutes. No patient had to be converted to a conventional approach. Hypocalcaemia or recurrent laryngeal nerve palsy were not observed postoperatively. Conclusion: Our preliminary results show that the ABBA technique is a feasible, safe procedure with excellent cosmetic benefits. The small scars in the right axilla and bilateral nipple areola are almost invisible.