Endoscopic transaxillary approach to the thyroid gland: our early experience

Background: Thyroid nodules are a common occurrence in clinical practice today. Most nodules are benign and can be managed nonoperatively with careful medical follow-up. However surgical extirpation occasionally becomes necessary to exclude a malignant neoplastic process. Although the majority of surgically excised thyroid lesions are histologically benign, patients are traditionally left with a permanent transverse surgical scar in a highly visible area of the neck. Materials and Methods: From August 2003 to August 2005, we performed a transaxillary endoscopic thyroid lobectomy with isthmectomy in 32 patients. We used a 3-port technique with 5-mm trocars and surgical instrumentation. A 5-mm 45-degree angled endoscope was used for visualization during the procedure. The CO2 insufflation pressure was set to 6-8 mmHg, and dissection was carried out using a 5-mm harmonic scalpel (Ethicon Endo-Surgery (TM)). Results: All patients underwent successful completion of thyroid lobectomy and isthmectomy. No conversion to open operation was required in this series. The mean operating time was 138.5 min, and the mean blood loss was 36.4 ml. The recurrent laryngeal nerve was identified in each case, and there was no permanent injury to this structure. There were two cases of temporary hoarseness that resolved spontaneously. One patient in this series had to be returned to the operating room for evacuation of a postoperative hematoma from an active bleeding vessel on the surface of the pectoralis major muscle. All patients were discharged on the first postoperative day. Conclusions: Transaxillary endoscopic thyroidectomy is a safe and feasible alternative to the traditional open surgical approach in select patients requiring surgical removal of the thyroid gland. The resultant improved cosmetic outcome and enhanced operative visualization may offer a practicable alternative for select patients requiring surgical removal of the thyroid gland.