Treatment of bifid ribs by gasless endoscopy using lift device / 中华胸心血管外科杂志

Objective:Gasless laparoscopic surgery using lifting device was first introduced in 1993 mainly for general surgery and gynecology. Here we report its application in bifid rib treatment and explore the feasibility and safety of the surgery.Methods:From July 2008 to December 2019, according to the enrollment criteria, 278 patients of bifid ribs were treated at the Department of Thoracic Surgery, Beijing Children’s Hospital, Capital Medical University, including 183 males and 95 females, the mean age was(5.7±2.5) years old. There were 242 cases of single bifid rib and 36 cases of multiple bifid ribs. The bifid ribs were more common on the right side, as 184 cases had bifid ribs on right side, while only 68 cases on the left side and 26 cases on both sides. Patients’ clinical data were retrospectively summarized and analyzed, including the patients’ gender, age, location and type of bifid rib, perioperative outcome, and follow-up.Results:All the 278 patients successfully completed the operation. The abnormality was most frequently found in the fifth rib(incidence ranking: fifth > fourth > third > sixth). The mean operation time was(64.5±16.1)min, and the mean blood loss was(4.8±2.1)ml. No serious complications occurred during the surgery. Follow-up was done for 7 to 120 months, and no recurrent patients were observed.Conclusion:Gasless endoscopy with lifting device has been used as a safe and effective method to treat bifid ribs in our hospital. This surgery leads to less injury, smaller incision, and no scars on the front chest. Gasless endoscopic surgery with lifting device can be one of the options for correcting bifid ribs.

Comparison between gasless endoscopic thyroidectomy and CO2- insufflation endoscopic thyroidectomy / 中国医师进修杂志

Objective To compare the surgical effect of gasless endoscopic thyroidectomy and CO2- insufflation endoscopic thyroidectomy, and evaluate the safety and applicability of gasless endoscopic thyroidectomy. Methods A prospective randomized controlled study was carried out.Sixty patients who were scheduled for bilateral thyroid surgery under endoscope were divided into 2 groups by sortition method: gasless group (30 patients, treated with gasless endoscopic thyroidectomy) and CO2-insufflation group (30 patients, treated with CO2-insufflation endoscopic thyroidectomy). The data of arterial partial pressure of carbon dioxide (PaCO2) and pH value before operation and 60 min after operation were detected. The operation time, intraoperative bleeding, time of putting the drain, hospitalization time after operation and postoperative complications were recorded. Results All the 60 patients completed endoscopic surgery,and no case was converted to the conventional procedure.There were no statistical differences in PaCO2and pH value before operation between 2 groups(P>0.05).The PaCO260 min after beginning of operation in gasless group was significantly lower than that in CO2-insufflation group:(36.43 ± 1.98)mmHg(1 mmHg=0.133 kPa)vs.(37.93 ± 3.27)mmHg,the pH value 60 min after beginning of operation was significantly higher than that in CO2-insufflation group:7.42 ± 0.02 vs. 7.37 ± 0.01, and there were statistical differences (P<0.05 or <0.01). There were no statistical difference in operation time, intraoperative bleeding, time of putting the drain, hospitalization time after operation and incidence of hoarseness between 2 groups (P>0.05). There were no complications related with trachea, parathyroid gland and superior laryngeal nerve in 2 groups. The incidence of CO2retention related complications in gasless group was significantly lower than that in CO2-insufflation group: 6.7% (2/30) vs. 43.3% (13/30), and there was statistical difference (P<0.01). Conclusions The modified spring suspension gasless endoscopic thyroidectomy not only acquires the equivalent surgical effect and indication,compared with the CO2-insufflation endoscopic surgery,but also is safer and has lower incidence rate of CO2retention related complications.

A systematic review on efficacy and safety of gasless laparoscopy in the management of uterine leiomyoma / 华中科技大学学报（医学）（英德文版）

Uterine leiomyoma causes considerable morbidity in women. This study systematically reviewed the efficacy and safety of gasless laparoscopic myomectomy (GLM) in the management of uterine leiomyoma by comparing GLM with other minimally invasive procedures. Cochrane Library, Pub- Med, EMBASE, Web of Science, WANFANG database and China National Knowledge Infrastructure (CNKI) were searched for studies published in English or Chinese between January 1995 and May 2015, and related references were traced. Study outcomes from randomized controlled trials and retrospective cohort studies were presented as mean difference (MD) or odds ratio (OR) with a 95% confidence interval (CI). Seventeen studies (including 1862 patients) meeting the inclusion criteria, including 934 treated with GLM and 928 treated with other minimally invasive procedures were reviewed. The results of meta-analysis revealed that GLM resulted in significantly shorter operating time [MD=-10.34, 95% CI (-18.12,-2.56), P<0.00001], shorter hospital stay [MD=-0.47, 95% CI (-0.88,-0.06)], less time to flatus [MD=-2.04, 95% CI (-2.59,-1.48)], less postoperative complications [OR=0.20, 95% CI (0.06, 0.62)] and less blood loss [MD =-30.74, 95% CI (-47.50,-13.98)]. On the other hand, there were no significant differences in duration of post-operative fever [MD=-0.52, 95% CI (-1.46, 0.42)] between the two groups. Additionally, GLM was associated with lower febrile morbidity, lower postoperative abdominal pain, and higher postoperative hemoglobin than other minimally invasive procedures for the treatment of uterine leiomyoma. In conclusion, GLM and other minimally invasive procedures are feasible, safe, and reliable for uterine leiomyoma treatment. However, available studies show that GLM is more effective and safer than other minimally invasive approaches.

Gasless laparoscopic surgery plus abdominal wall lifting for giant hiatal hernia-our single-center experience / 华中科技大学学报（医学）（英德文版）

Giant hiatal hernia (GHH) comprises 5% of hiatal hernia and is associated with significant complications. The traditional operative procedure, no matter transthoracic or transabdomen repair of giant hiatal hernia, is characteristic of more invasion and more complications. Although laparoscopic repair as a minimally invasive surgery is accepted, a part of patients can not tolerate pneumoperitoneum because of combination with cardiopulmonary diseases or severe posterior mediastinal and neck emphesema during operation. The aim of this article was to analyze our experience in gasless laparoscopic repair with abdominal wall lifting to treat the giant hiatal hernia. We performed a retrospective review of patients undergoing gasless laparoscopic repair of GHH with abdominal wall lifting from 2012 to 2015 at our institution. The GHH was defined as greater than one-third of the stomach in the chest. Gasless laparoscopic repair of GHH with abdominal wall lifting was attempted in 27 patients. Mean age was 67 years. The results showed that there were no conversions to open surgery and no intraoperative deaths. The mean duration of operation was 100 min (range: 90-130 min). One-side pleura was injured in 4 cases (14.8%). The mean postoperative length of stay was 4 days (range: 3-7 days). Median follow- up was 26 months (range: 6-38 months). Transient dysphagia for solid food occurred in three patients (11.1%), and this symptom disappeared within three months. There was one patient with recurrent hiatal hernia who was reoperated on. Two patients still complained of heartburn three months after surgery. Neither reoperation nor endoscopic treatment due to signs of postoperative esophageal stenosis was required in any patient. Totally, satisfactory outcome was reported in 88.9% patients. It was concluded that the gasless laparoscopic approach with abdominal wall lifting to the repair of GHH is feasible, safe, and effective for the patients who cannot tolerate the pneumoperitoneum.

Gasless laparoscopic anatomy and renal biopsy of the kidney in the standing mare / Anatomía laparoscópica sin gas y biopsia renal de los riñones de la yegua de pie

The current study aimed to provide the topography and renal biopsy of the standing mare kidneys by laparoscopy w ithout CO2 insufflation and to compare between the use of biopsy needle and forceps. Five clinically healthy adult nonpregnant mares weighing 250­300 Kg and aging 7­9 years were used in the current work. The gasless laparoscopic renal biopsy appeared simple, safe, reliable, minimal invasive, timesaving and economical technique. The parallel biopsy portals provided easy and accessible biopsy procedure than dorsal or ventral portals. The biopsies taken from the lateral surface were less hemorrhagic than those taken from the caudal pole. This study recommended the laparoscopic forceps because the biopsy forceps provided satisfactory and representative specimens with minimal hemorrhage than Tru-cut needle.

El presente estudio tuvo como objetivo proporcionar la topografía y la biopsia renal de los riñones en la yegua de pie, por laparoscopía sin insuflación de CO2, y comparar entre el uso de la biopsia con aguja y pinzas. Fueron utilizadas en este studio cinco yeguas adultas no gestantes clínicamente sanas con un peso de 250­300 Kg y edad de 7­9 años. La biopsia renal laparoscópica sin gas es un método seguro, confiable y mínimamente invasivo, económico y permite además ahorrar tiempo. Los portales de biopsia paralelas permiten un procedimiento de biopsia de fácil acceso. Las biopsias tomadas de la superficie lateral fueron menos hemorrágicas que aquellas obtenidas desde el polo caudal. Este estudio recomienda las pinzas laparoscópicas debido a que, a diferencia de la aguja Tru-cut, demostraron ser satisfactorias con una hemorragia mínima.

Gasless Laparoscopic Surgery for Benign Ovarian Tumors during Pregnancy:a Report of 45 Cases / 中国微创外科杂志

Objective To investigate the feasibility, safety and effect of gasless laparoscopic surgery in the treatment of benign ovarian tumors during pregnancy. Methods Clinical data of 45 pregnant women with benign ovary tumors undergoing gasless laparoscopic surgery from January 2006 to June 2013 were studied retrospectively.Most of the cases were given oophorocystectomy. Adnexectomy was performed for the large sized lesions, lacking of or remaining few normal ovarian tissue, or ovarian cyst torsion. Results All the 45 cases were successfully treated by gasless laparoscopic surgery.No perioperative and postoperative complications were observed.There were 42 cases receiving ovarian tumor resection while 3 cases receiving simple salpingo-oophorectomy.The mean operation time was (40.7 ±14.9) min (25-90 min), the mean blood loss was (27.3 ±16.6) ml (10 -80 ml), and the mean hospitalization time was (4.5 ±1.3) days (3-8 days).At pre-, peri-, and post-operative time, the blood pH value, blood pressure carbon dioxide (PaCO2), and blood oxygen partial pressure (PaO2) showed no statistical difference (F=0.00,P=0.999;F=2.21, P=0.114;F=0.60,P=0.555), and blood bicarbonate (HCO3-) and blood oxygen saturation (SpO2) showed statistical difference but no clinical significance (F=14.96,P=0.000;F=9.45,P=0.999), all of which were in the normal range.The fetal heart rates were all in the normal range.Pathological diagnoses were ovarian mature cystic teratoma in 25 cases (55.6%), serous cystadenoma in 6 cases (13.3%), mucinous cystadenoma in 4 cases (8.9%), mesosalpinx cyst in 3 cases (6.7%), endometrial cyst in 2 cases (4.4%), and luteal cyst in 5 cases (11.1%).No spontaneous abortion was found in post-operational follow-up.Term delivery was obtained in 43 cases, with normal fetal weight and the Apgar scores.Two cases gave up the pregnancy in the postoperative period. Conclusion Gasless laparoscopic surgery for benign ovarian tumors during pregnancy is safe and feasible.

Gasless single-incision laparoscopic cholecystectomy / 中华消化外科杂志

Laparo-endoscopic single site (LESS) surgery is in line with the development trend of minimally invasive surgery.Resolving the problems caused by the tiny single trocar is very important for the popularizing of LESS surgery.From February to September in 2012,34 patients with cholecystolithiasis or polypoid lesions of the gallbladder received gasless singleincision laparoscopic cholecystectomy at the Xuanwu Hospital.All the operations were successfully done,with no conversion to conventional laparoscopic surgery or open surgery.The mean operation time,intraoperative blood loss and duration of postoperative hospital stay were 70 minutes (range,45-135 minutes),18 ml (range,5-40 ml) and 3.4 days (range,3-4 days).There was no complication within the follow-up of 3 weeks,and all patients recovered well with satisfied cosmetic effect.Combination of gasless single-incision laparoscopic techniques could decrease the difficulty of LESS surgery and help to popularize LESS surgery.

A Preliminary Study for Randomized, Controlled Trial of On-Q® PainBuster® Pain Pump vs. Intravenous Patient-controlled Analgesia after Gasless Transaxillary Endoscopic Thyroidectomy / 대한내분비외과학회지

PURPOSE: Gasless transaxillary approach to endoscopic thyroidectomy is a widely performed procedure for benign or malignant thyroid neoplasms. However, it requires wide dissection for approaching the target area. The intravenous patient-controlled analgesia (IV PCA) is an effective method for postoperative pain control and patients can use it according to their requirement. However, patients suffer from nausea, vomiting, sleep disturbance, etc. due to opioids. Pain pump ON-Q® PainBuster® (pain buster) has been used widely in various surgeries for control of postoperative localizing and wide area pain without side effects of opioid analgesia because it consists of Ropivacaine. METHODS: From Aug. 2008 to Jan. 2013, Gasless transaxillary endoscopic thyroidectomy was performed in 90 patients in a single institution, who were divided into three groups, including the IV PCA, pain buster, and null groups. We compared postoperative outcomes, pain severity between groups. We recorded scores immediately, 6, 12, 24, and 48 hours after surgery following visual analog pain score (VAS), and investigated hospital stay and occurrence of events of nausea, vomiting, and complications. RESULTS: In the IV PCA group, it was discontinued due to nausea in 36.7% of patients. No significant difference in pain severity following VAS score was observed among the three groups. However, smaller numbers of analgesia injections were required in the Pain buster group than in the other groups, and fewer patients suffered from constipation, compared with the PCA group. CONCLUSION: Pain buster showed even effects compared to IV PCA, with few side effects and less discomfort of patients, compared with the other groups. Therefore, pain buster was thought to be the proper method for pain control after dissection of the anterior chest wall, cervical area in order to secure an operative view for transaxillary endoscopic thyroidectomy.

Analysis of relative factors on the working space for operations in gasless laparoscopic cholecystectomy / 国际外科学杂志

Objective To investigate the potential factors which have impact on the working space for surgeons in gasless laparoscopic cholecystectomy and to probe into the specifications of gasless surgeries.Methods Clinical data of 49 cases of gasless laparoscopic cholecystectomy between March 2007 and July 2010 were summarized.The impacts of body mass index,bowel preparation and means of anesthesia on operation time and conversion to laparotomy were analyzed.Results For patients with body mass index ≤25and ＞ 25,operation times were (43.0 ± 5.4) min,and (52.8 ± 7.4 ) min,respectively,and rates of conversion to laparotomy were 0/34 and 4/15,respectively.Both indices in the first group were higher.For patients with and without bowel preparation,operation times were (44.5 ± 5.4) min and (46.1 ± 8.0)min,respectively,and rates of conversion to laparotomy were 2/26 and 2/23,respectively.For patients with epidural anesthesia and lumbar/epidural anesthesia,operation times were (46.5 ± 7.9) min and (44.1 ±6.8) min,respectively,and rates of conversion to laparotomy were 2/24 and 2/25,respectively.Conclusions The operation time of gasless laparoscopic cholecystectomy could be affected by many factors,such as body mass index.Gasless operations can be improved by evaluating the conditions of patients correctly and by selecting suitable operation methods,anesthesia means and bowel preparation.

Gasless Laparoscopic Assisted Transumbilical Appendectomy / 대한내시경복강경외과학회지

PURPOSE: This study evaluated the safety and feasibility of gasless laparoscopic assisted transumbilical appendectomy (GLATUA). METHODS: Data for 62 GLATUA and 84 laparoscopic appendectomies (LA) for uncomplicated appendicitis, which had been performed over a 12 month period in a single institution, were compared retrospectively. The GLATUAs were carried out through an umbilical incision. The abdominal wall was retracted upward using an "L"-shaped retractor and the inflamed appendix was found by gasless laparoscopic vision. A transumbilical extracorporeal appendectomy was then performed. The LAs were performed using a three-port system. RESULTS: The GLATUA group had a shorter mean operative time (44.1+/-22.1 vs. 51.5+/-24.7 min, p=0.06), mean time for resuming a soft diet (29.0+/-9.2 vs. 41.3+/-20.7 hrs, p<0.01) and hospital stay (3.0+/-0.9 vs. 3.6+/-1.7, p<0.01) than the LA group. There was no significant difference in complication rates (6.5% vs. 3.6%, p=0.44). The mean medical costs of the GLATUA group were 66.7% of the LA group. CONCLUSION: GLATUA is a safe, feasible and more cost-effective alternative technique for surgery in uncomplicated acute appendicitis than LA.

Neonatal gastric volvulus: another cause of “Mucousy Baby” with gasless abdomen.

Neonatal acute gastric volvulus is rare and often associated with diaphragmatic anomalies. Patients usually present with vomiting and respiratory distress, but excessive salivation, failure to pass a nasogastric tube beyond 20 cms and the presence of a space occupying thoracic lesion should also prompt a search for the entity. The authors describe a case presenting with these atypical findings and stress the importance of the plain radiograph chest to make a diagnosis.

10 Year-Experience of Endoscopic Thyroidectomy for Papillary Thyroid Microcarcinoma in Single Institution: Breast Approach and Gasless Transaxillary Approach

PURPOSE: Endoscopic thyroid surgery has been widely used because of the cosmetic advantage and the development of laparoscopic instruments. We have performed endoscopic thyroidectomy by breast approach and gasless transaxillary approach on papillary thyroid microcarcinomas. In this study, we describe these two types of endoscopic procedures with the technique of the method and surgical outcomes. METHODS: From Oct. 1999 to Oct. 2009, each procedure was performed in 162 patients divided into two groups. Breast approach group was in 91 patients and gasless transaxillary approach group was in 71 patients. We compared the results of mean ages, sex ratio, extent of operation, mean hospital stay, operating time, pathologic characteristics and postoperative complications between the breast approach group and gasless transaxillary approach group. RESULTS: Ninety-one cases treated using breast approach, and seventy-one cases treated using gasless transaxillary approach. The operation time was 197.4+/-60.7 minutes (95~350) in breast approach group, and 100.1+/-19.8 minutes (65~140) in gasless transaxillary approach group. Post operative complications are; 2 cases of transient hoarseness, 8 cases of hypocalcemia (including 2 cases of permanent hypocalcemia), 2 cases of chest wall discomfort in breast approach group, and 1 case of transient hoarseness, 2 cases of transient hypocalcemia, 1 case of postoperative bleeding in gasless axillary approach group. CONCLUSION: Endoscopic thyroidectomy is a safe and technically feasible alternative to conventional thyroidectomy in patients with benign and highly selected malignant disease. We expect it can increase the extent of surgery.

Initial Experience Using Gasless Transaxillary Robotic Thyroidectomy by a Single Surgeon / 대한내분비외과학회지

PURPOSE: Various endoscopic thyroidectomy procedures have been designed to minimize visible cervical scarring. However, endoscopic thyroidectomy is a technically challenging procedure that is performed by a limited surgeon. Robotic systems aida surgeon in performing minimally invasive head and neck surgery by offering superior visualization and dexterity. This study reports the initial experience of one surgeon with robotic thyroidectomy to assess the technical feasibility and safety of the approach. METHODS: One hundred four thyroid cancer patients (97 females, 7 males; mean age of 39.8±8.1 years) underwent robotic thyroidectomy using gasless transaxillary approach between November 2008 and October 2009 in Ajou University Hospital. All the procedures were completed successfully using the da Vinci surgical system without open conversion. Patient characteristics, postoperative clinical results, complications, and pathologic details were assessed. RESULTS: Total thyroidectomy was performed in 25 (24.0%) patients, subtotal thyroidectomy in 13 (12.5%) patients, and unilateral lobectomy in 66 (63.5%) patients. All patients underwent ipsilateral central compartment neck dissection, and two patients underwent selective lymph node (LN) dissection. The mean operation time was 134.5±47.2 min (range 61~310 min), in which the actual time for the thyroidectomy with lymphadenectomy (console time) was 56.4 min. (range 31~270). The mean number of LN resected was 3.9 (range 0~28). There were no serious complications. The mean hospital stay was 2.9±0.9 days (range 2~7). CONCLUSION: Robotic thyroidectomy is a feasible, safe, and cosmetically excellent procedure. The application of robotic technology for thyroid surgeries could be an alternative to endoscopic or conventional open thyroidectomy.

Gasless laparoscopic surgery using abdominal wall lifting technique in the field of general surgery / 国际外科学杂志

Complications related to CO2 pneumoperitoneum in laparoscopy surgery have led to the devel-opment of gasless laparoscopic surgery using abdominal wall lifting technique.The technique uses facilitate laparoseopic surgery without conventional pneumoperitoneum and markly reduced in the risks of anesthesiolo-gy,especially in old patients with cardiopulmonary insufficiency.The review summarizes the application of gasless laparoscopie surgery using abdominal wall lifting technique in the field of general surgery.

Gasless Endoscopic Thyroidectomy using the Trans-axillary Approach: Surgical Outcomes of 634 Patients / 대한내분비외과학회지

PURPOSE: Various techniques of minimally invasive thyroid surgery have been introduced during the past decade, including the endoscopic technique. We have developed a novel method of gasless endoscopic thyroidectomy via an axillary approach. The present report describes the technique of this method and the analysis of the surgical outcomes. METHODS: Between Dec. 2001 and Feb. 2008 (the actual operation period was 55 months), 634 patients with thyroid tumors underwent gasless endoscopic thyroidectomy via an axillary approach. The clinical and pathologic characteristics of the patients, the type of operation, the operative time, the post operative hospital stay and the post operative complications were retrospectively analyzed. RESULTS: Among the 634 patients, 176 patients had benign tumor and 458 patients had malignant tumor. The type of operationwas classified according to the extent of surgery. Lymphadenectomy (CCND, SND, MRND) was respectively performed for treating the patients with malignant tumor, depending on the indications. The mean operating time and the mean length of the post-operative hospital stay were 129.4±51.3 minutes, 3.3±1.7 days for benign tumor and 135.5±47 minutes, 3.4±0.9 days for malignancy, respectively. The mean tumor size was 2.7±1.2 (0.4~6.0) cm for benign tumor and 0.78±0.5 (0.1~4.0) cm for malignancy. Central compartment lymph node metastasis was found in 117 (25.6%) patients and lateral neck lymph node metastasis was found in 14 (3.0%) patients. There was no conversion to open thyroidectomy. As for the post-operative complications, transient hypocalcemia occurred in 19 patients, transient hoarseness was noted in 13 patients and permanent vocal cord palsy occurred in 2 patients. For the TNM stage, 406 (88.6%) patients were stage I, 51 (11.2%) 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 selected patients with benign tumors and it can be an effective treatment for selected patients who suffer with thyroid cancer.

Gasless Endoscopic Thyroidectomy using the Trans-axillary Approach for Benign Thyroid Tumor / 대한내분비외과학회지

PURPOSE: The techniques for minimally invasive surgery in various surgical fields have recently become markedly developed. The endoscopic surgical methods for head and neck surgery have been introduced somewhat later due to some technical limitations. However, various endoscopic techniques have been remarkably developed during the last 10 years. We also introduced a novel method of gasless endoscopic thyroidectomy using the trans-axillary approach. The aim of this study is to evaluate the feasibility and surgical outcome of this method for treating patients with benign thyroid tumor. METHODS: From Jan. 2002 to Dec. 2007, 171 patients with benign thyroid tumors underwent gasless endoscopic thyroidectomy via an axillary approach. We retrospectively analyzed the clinical and pathologic characteristics of the patients, the type of operation, the operative time, the post-operative hospital stay and the post-operative complications. RESULTS: Among the 171 patients, the mean age of the patients was 33.3±10.0 years and the gender ratio was 1: 84.5 (males-2, females-169). The type of operation was classified according to the extent of surgery and there was no conversion to open thyroidectomy. The mean operation time and the mean length of the post-operative hospital stay were 129.7±51.6 minutes and 3.3±1.7 days, respectively. The mean tumor size was 2.70±1.18 cm and the most common pathologic diagnosis was adenomatous hyperplasia (106 cases, 62%). For the post-operative complications, transient hoarseness occurred in 6 patients, transient hypocalcemia occurred in 1 patient and trachea and esophageal injury occurred in 1 patient each. A tumor size larger than 5 cm and concurrent thyroiditis at time of the operation both increased the mean operation time (P= 0.009, P=0.023). CONCLUSION: According to our experience, gasless endoscopic thyroidectomy using a trans-axillary approach is a feasible and safe method for treating benign thyroid tumor. Moreover, the cosmetic benefits can be maximized by this method as compared with the other methods. Endoscopic thyroid surgery has become a new treatment modality for selected patients with benign thyroid tumors.

A Clinical Application of Gasless Endoscopic Thyroidectomy: Clinical Analysis of 300 Cases at a Single Institution

PURPOSE: Endoscopic thyroidectomy has become a widely used operative method due to the recent advances in the operative technique and instruments and its cosmetic superiority. The aim of this study is to evaluate the technical feasibility and potential role of endoscopic thyroidectomy. METHODS: Between December 1999 and December 2006, 300 patients with benign thyroid disease or thyroid cancer were treated by gasless endoscopic thyroidectomy with using the anterior chest wall approach at Uijongbu St. Mary's Hospital. We analyzed that clinicopathological features, the operative time, the operative method and the complications. RESULTS: There were 261 cases of benign disease and 39 cases of malignant tumor. We generally performed lobectomy for benign thyroid disease. For malignant tumor, we performed 14 lobectomies, 6 total (or near total) thyroidectomies, 17 total (or near total) thyroidectomies with central lymph node dissection and 2 total (or near total) thyroidectomies with lateral lymph node dissection. The most frequent pathology in benign disease was nodular hyperplasia, and in malignant disease it was papillary carcinoma. The mean operative time was 122.2 minutes. For the patients with thyroid cancer, the mean operative time for thyroid cancer surgery without lymph node dissection (20 cases) and thyroid cancer surgery with lymph node dissection (19 cases) was 144 and 177 minutes, respectively. There were 34 cases of complication (11.33%) with 11 cases of transient hoarseness, 9 cases of transient hypocalcemia and 1 case of permanent hypocalcemia. CONCLUSION: Endoscopic thyroidectomy is a safe and technically feasible alternative to conventional thyroidectomy in patients with benign disease. In patients with thyroid cancer, we suggest that that endoscopic thyroidectomy can be a good alternative to conventional thyroid surgery in highly selected cases. Larger series and longer follow-up evaluation are necessary to confirm our findings.

Gasless Endoscopic Thyroidectomy via an Axillary Approach: Short-term Outcomes and Modifications of Approach / 대한내분비외과학회지

PURPOSE: With an accumulation of surgical experience for endoscopic or video-assisted thyroidectomy and improvements in surgical techniques and endoscopic instruments, these procedures have become a valid option for patients with benign thyroid nodules. These applications are now being expanded even to selected patients with low risk thyroid carcinomas. This study was performed to suggest new modified methods of approach on the use of a gasless endoscopic thyroidectomy via an axillary approach and to evaluate the short-term outcomes. METHODS: Between May 2004 and March 2007, 66 female patients underwent a gasless endoscopic thyroidectomy via an axillary approach. Surgical outcomes were evaluated in terms of surgical time, length of hospital stay, the incidence of perioperative complications, and patient opinion at two and four months after surgery. RESULTS: No cases required conversion to open surgery. The mean surgical time was 136.5±31.8 minutes, and the mean length of hospital stay was 4.2±1.1 days. There were two transient recurrent laryngeal nerve palsies, two minor tracheal injuries without air leakage, and two postoperative hemorrhages that required a second surgery. Only one patient (1.9%) and five patients (9.4%) complained of slight hypesthesia or paresthesia in the neck and anterior chest wall, respectively, and only three patients (5.7%) complained of discomfort while swallowing 4 months after surgery. CONCLUSION: Gasless endoscopic thyroidectomy via an axillary approach is a feasible and safe procedure and providesa minimal degree of postoperative complaints. This procedure is now a valid option for the surgical treatment of benign thyroid disease and its applications will broaden in the near future.

Endoscopic Thyroidectomy via Axillary Approach / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: A hypertrophic scar of the anterior neck is the leading complaint of patients who underwent conventional thyroid surgery. In order to minimize the postoperative scars, endoscopic thyroidectomy via axillary approach was tried. SUBJECTS AND METHOD: Thirty-nine cases (female 37, male two, average age 36.3 yrs) with either benign unilateral thyroid nodule or cyst underwent endoscopic thyroidectomy. Under general anesthesia, less than 7 cm of skin incision was made in the axilla of the same side and subcutaneous tunnel was made over the clavicle. Specially created retractor was placed within the tunnel between platysma and sternocleodomastoid muscle, and under rigid endoscope (4 mm, 5 mm ; 0degrees, 30degrees) thyroidectomy was performed. RESULTS: There were 35 cases of thyroid nodulectomy, one case of isthmusectomy, and three cases of subtotal lobectomy. Complete enucleations with the intact capsule were 13 cases, 24 cases with partial rupture of the capsule, and two cases with incomplete removal of the capsule. The mean operative time was 112.5 minutes. Postoperative complications included one case of postoperative bleeding, two cases of delayed wound healing, three cases of paresthesia of shoulder and arm, and five cases of hypertrophic scar of the axilla. For all cases, hospitalization period was two days. CONCLUSION: Endoscopic thyroidectomy via axillary approach has an excellent cosmetic advantage; however, the procedure requires longer operation time of about three times the conventional method. Operation time can be reduced with the development of more versatile surgical tools. However, limited thyroidectomy surgery can not be avoided.

Gasless Endoscopic Thyroidectomy Via an Axillary Approach

PURPOSE: Surgery for thyroid disease requires skin incisions that can result in postsurgical problems, such as prominent scars, adhesions and hypesthesia, as well as paresthesia of the neck. To overcome these problems we performed a gasless endoscopic thyroidectomy via an axillary approach. METHODS: Between November 2001 and April 2005, 141 patients underwent a gasless endoscopic thyroidectomy via an axillary approach. The surgical outcomes were evaluated in terms of the operating time, length of hospital stay and the incidence of perioperative complications. Patient opinions were assessed using a verbal response scale at two and four months after surgery. RESULTS: The mean operating time and length of hospital stay were 122.7+/-32.8 minutes and 3.4+/-0.9 days, respectively. No cases required either conversion to open surgery or involved significant intraoperative complications. Two months after surgery, 75 patients (53.2%) complained of hypesthesia or paresthesia in the anterior chest wall. The number of patients with such complaints (9.9%) had decreased 4 months after surgery (P<0.001). Four months after surgery, only 4 patients (2.8%) complained of hypesthesia or paresthesia in the neck, and 10 (7.1%) complained of discomfort while swallowing. All patients were satisfied with the cosmetic results. CONCLUSION: A gasless endoscopic thyroidectomy via an axillary approach is feasible and safe, and provides excellent cosmetic results, with a minimal degree of postoperative complaints. This procedure provides another surgical option for the treatment of benign thyroid disease in selected patients.