ABSTRACT
Objective@#To evaluate the significance for the preservation of the supraclavicular nerve in endoscopic thyroidectomy via gasless anterior chest approach.@*Methods@#We retrospectively evaluated 168 patients who underwent unilateral endoscopic thyroidectomy via gasless anterior chest approach, with preservation of the medial branch of the supraclavicular nerve in 110 patients and not in other 58 patients. Semmes-Weinstein monofilament (SWM) test and a visual analogue scale (VAS) were used to assess the recovery of sensation in anterior chest within 1-12 months postoperatively. Difference in the scores of SWM or VAS between groups was tested with Mann-Whitney U test, and the rates of SWM and VAS scores returning to normal levels in individual periods after surgery was compared with Chi-square test.@*Results@#The preserved group showed more favorable results than the non-preserved group in both SMW and VAS scores. Compared to control group, SWM score in preserved group possessed a higher rate recovery to normal level at any period after operation, which was close to complete normality in 7-9 months postoperatively, and SWM score in non-preserved group was still partially normal in 10-12 months from surgery. Preferable results for VAS were also found in the preserved group, except no significant difference in VAS between groups in1-3 months or 10-12 months after operation.@*Conclusion@#Preservation of the medial branch of the supraclavicular nerve in endoscopic thyroidectomy via gasless anterior chest approach can improve sensation recovery in anterior chest, thus improving postoperative quality of life of patients.
ABSTRACT
PURPOSE: The thyroid suregry has recently become one of the newest fields for the application of endoscopic surgery. We have performed endoscopic thyroidectomy by an anterior chest approach and an axillary approach. In this study, we evaluated these two types of endoscopic procedures with regard to efficacy and patients' complaints after surgery. METHODS: Between December 2000 and March 2002, 41 patients were treated by endoscopic thyroidectomy via axillary or anterior chest approach. Each procedure was performed by one surgeon under a general anesthesia. We analysed the operating time, postoperative complications, postoperative scar, the degree of pain to assess the surgical invasiveness of each procedure. RESULTS: Three cases treated using anterior chest approach, and 2 cases treated using axillary approach were converted to conventional thyroidectomy. The mean age of patients was 36 years in anterior chest approach group and 30 years in axillary approach group. The operation time was 238±60 (160~370) minutes in anterior chest approach and 178±71 (100~295) minutes in axillary approach. Postoperative complications are; 1 case of a minimal hematoma, 3 cases of minor wound infection, 3 cases of chest pain in anterior chest approach group, and 1 case of a minimal hematoma, 1 case of transient recurrent laryngeal nerve injury, 1 cases of transient swallowing difficulties in axillary approach group. CONCLUSION: Endoscopic (gasless and axillary approach) thyroidectomy is a safe and effective procedure. Gasless endoscopic thyroidectomy is a useful procedure for unexperienced surgeon due to safety. Endoscopic thyroidectomy by the axillary approach is a better effective procedure with good cosmetic result for a unilateral tumor especially in young women.