Incision scar recovery assessment of patients with transaxillary dual-plane breast augmentation assisted with endoscopy / 中华医学美学美容杂志

Objective:To evaluate incision scars of transaxillary breast augmentation by different methods of scar assessment.Methods:A retrospective study was carried out on 30 patients (age range 20 to 50 years, with mean age of 32 years) who underwent endoscopic assisted transaxillary type Ⅰ dual plane breast implant augmentation by a same surgeon from August 2014 to November 2016. Scars were estimated by 3 methods which included Vancouver Scar Scale (VSS), Visual Assessment Scale (VAS) and patients' questionnaire.Results:VAS score for left side scars ranged from 0 to 8 and the median was 1. VAS score for right side scars ranged from 0 to 8.3 and the median was 1. A total of 48 scars were scored in the 0-2 point range, representing 80% of the 60 total. VSS score for left side scars ranged from 0 to 11.6 and the median was 0.8. VSS score for right side scars ranged from 0 to 11.3 and the median was 1.2. A total of 46 scars were scored in the 0-2 point range, representing 76.7% of the total 60 breats. The scores between VSS and VAS had significant statistical differences ( P<0.001). 80.0% of our patients regarded scars as unconspicuous or basically invisible in our questionnaire. Conclusions:The majority of transaxillary incision scars recover in favorable status with high patients satisfactory rate. VAS is a practical tool for evaluating transaxillary incision scars. The VSS score is not equivalent to the VAS score when grading scars only by photos.

Effects of transaxillary approach endoscopic and traditional open radical thyroidectomy on the levels of inflammatory factors in patients with thyroid cancer / 中国医师进修杂志

Objective:To investigate the effects of transaxillary endoscopic and traditional open radical thyroidectomy on the levels of inflammatory factors in patients with thyroid cancer.Methods:The clinical data of 102 thyroid cancer patients underwent radical thyroidectomy from October 2019 to October 2021 in Xinjiang Medical University Hospital of Chinese Medicine were retrospectively analyzed. Among them, 50 cases underwent transaxillary approach endoscopic radical thyroidectomy (study group), and 52 cases underwent open radical thyroidectomy (control group). The operation related indexes were compared between two groups, including operation time, intraoperative blood loss, postoperative drainage, lymph node clearance and hospital stay; the pain scores 1, 3 and 7 d after operation were recorded; the levels of interleukin-6 (IL-6), interleukin-10 (IL-10), galectin-3 (Gal-3) and tumor necrosis factor-α (TNF-α) before operation and 1 d after operation were measured by enzyme-linked immunosorbent assay; the postoperative complications were recorded, including hoarseness, limb numbness, cough after drinking water and hypocalcemia; and the cosmetic satisfaction was followed up 3 months after discharge, and the recurrence was observed by CT 6 months after discharge.Results:The operation time in study group was significantly longer than that in control group: (88.69 ± 15.16) min vs. (61.47 ± 15.48) min, while the intraoperative blood loss, postoperative drainage and hospital stay were significantly lower in control group: (51.21 ± 10.06) ml vs. (85.46 ± 11.37) ml, (98.29 ± 30.61) ml vs. (117.47 ± 30.25) ml and (5.35 ± 0.54) d vs. (7.72 ± 0.61) d, and there were statistical differences ( P<0.01); there was no statistical difference in lymph node clearance between two groups ( P>0.05). The pain score 1 and 3 d after operation in study group was significantly lower than that in control group: (5.13 ± 1.07) scores vs. (7.87 ± 1.46) scores and (4.22 ± 1.35) scores vs. (6.42 ± 1.28) scores, and there were statistical differences ( P<0.05); there was no statistical difference in pain score 7 d after operation between two groups ( P>0.05). There were no statistical differences in IL-6, IL-10, TNF-α and Gal-3 between two groups ( P>0.05); the IL-6, IL-10, TNF-α and Gal-3 1 d after operation in study group were significantly lower than those in control group: (26.27 ± 3.14) ng/L vs. (29.22 ± 4.52) ng/L, (7.54 ± 2.31) ng/L vs. (10.92 ± 2.54) ng/L, (14.98 ± 3.76) μg/L vs. (23.65 ± 2.46) μg/L and (3.54 ± 0.48) μg/L vs. (4.48 ± 0.63) μg/L, and there were statistical differences ( P<0.01). There was no statistical difference in the incidence of total complications between two groups ( χ2 = 1.73, P>0.05). The total satisfaction rate in study group was significantly higher than that in control group: 94.0% (47/50) vs. 78.8% (41/52), and there was statistical difference ( χ2 = 4.94, P<0.05). The patients were followed up for 6 months after discharge, and there was no recurrence. Conclusions:The transaxillary approach endoscopic radical thyroidectomy can reduce intraoperative blood loss, length of stay, postoperative drainage, postoperative pain, and to some extent inhibit inflammatory response. It can improve the postoperative cosmetic satisfaction, reduce the incidence of postoperative complications, and does not increase the recurrence rate

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.

Comparison Study of Endoscopic Thyroidectomy Versus Robot-assisted Thyroidectomy by a Cervico-transaxillary Approach / 대한내분비외과학회지

PURPOSE: Endoscopic and robot-assisted thyroidectomy has shown rapid development worldwide. In addition, there is no treatment of choice for thyroidectomy as usual. We propose an endoscopic thyroidectomy using a cervico-transaxillary approach, comparing its results with those of robot-assisted thyroidectomy. We present this study in order to provide advantages and disadvantages. METHODS: Between January 2010 and March 2012, 132 patients were recruited with clinicopathological data for this study. We divided patients into two groups, the endoscopic and the robot groups, with respect to their clinical characteristics, surgical outcomes. The outcomes were evaluated in terms of operation time, estimated blood loss, hemovac amount, hospital stay, and number of lymph nodes harvested. RESULTS: A total of 132 patients (male 6 and female 126) were recruited with clinicopathological data for this study. Of these, 78 patients underwent endoscopic thyroidectomy (the endo group) and 54 underwent robot-assisted thyroidectomy (the robot group) using a cervico-transaxillary approach. The two groups did not differ significantly in terms of age, estimated blood loss, and complications. None of the patients experienced severe complications. CONCLUSION: Results of the preliminary comparison in this study show that both approaches are safe and feasible, with similar results. However, a smaller hemovac amount was observed with endoscopic thyroidectomy, compared to robot-assisted thyroidectomy. In order to cut costs, part of robot-assisted thyroidectomy could be replaced by endoscopic thyroidectomy.

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.

Consideration of Complications after Gasless Transaxillary Endoscopic Thyroidectomy / 대한내분비외과학회지

PURPOSE: Gasless transaxillary endoscopic thyroidectomy has become a widely used surgical alternative due to the recent advances in the operative techniques and laparoscopic instruments, and its cosmetic superiority. The aim of this study is to analyze the factors associated with complications following surgery by reviewing 49 patients who underwent gasless transaxillary endoscopic thyroidectomy. METHODS: Between Nov. 2006 and Jun. 2009, 49 patients underwent gasless transaxillary endoscopic thyroidectomy via an axillary approach. The clinical and pathologic characteristics, operation type, postoperative hospital stay, operation time and post operative complications were retrospectively analyzed. RESULTS: Among the 49 patients, 37 had benign tumors and 12 had malignant tumors. Unilateral thyroid lobectomies were generally performed for benign tumors. For malignant ones, 7 lobectomies and 5 lobectomies with central lymph node dissection were done. In pathological review, most common benign disease was nodular hyperplasia, and the most common malignancy was papillary microcarcinoma. The mean operative time was 160.7±38.2 minutes (100~295). The postoperative complications were as follows; neck and anterior chest discomfort (19 cases), operation wound infection (5 cases), seroma (3 cases), swallowing difficulty (3 cases) and hoarseness (3 cases). CONCLUSION: Gasless transaxillary endoscopic thyroidectomy is a feasible and safe operation, and provides excellent cosmetic results. But there are still postoperative complications, it should be considered to reduce.

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.

Endoscopic Transaxillary Dual Plane Breast Augmentation

PURPOSE: The transaxillary approach for breast augmentation has been advocated for patients and surgeons for several decades. However, this blind technique had many disadvantages including, traumatic dissection, difficult hemostasis, displacement of implants, and ill-defined asymmetrical location of inframammary crease. In the present study, the precise endoscopic electrocautery dissection was applied to eliminate the limits of blunt dissection throughout the procedures. METHODS: From December 2006 to December 2007, a total of 103 patients with an average age of 29.5 years underwent endoscopic assisted transaxillary dual plane augmentation mammoplasty. The mean implant size was 243 cc with the range between 150 and 350cc. Through a 4cm axillary incision, electrocautery dissection for submuscular pockets was carried out under the endoscopic control. The costal origin of pectoralis muscle was completely divided to expose subcutaneous tissue and to make type I dual plane. RESULTS: Using the endoscopic dissection, we achieved good aesthetic results including a short recovery period, less morbidity, and symmetrical well-defined inframammary crease. Type I dual plane procedure could support the consistent inframammary fold shape and be applied to most patients without breast ptosis. Minor complications did not occur, however, four major complications of capsular contracture occurred. CONCLUSION: In contrast to the era of the blind techniques, endoscopic assisted transaxillary dual plane breast augmentation can now be performed effectively and reproducibly. With Its advantage, the axillary application of endoscopy for augmentation mammaplasty is useful to achieve the optimal cosmetic outcomes.

A Case of Brachial Plexus Schwannoma

Brachial plexus schwannoma is rare. A case of a 28-year old woman who complained of a palpable mass in the right axilla is presented. She had previous incisional biopsy on the axillary mass. Brachial plexus magnetic resonance imaging revealed a well circumscribed contrast enhancing mass on the right distal cord of the brachial plexus. EMG revealed normal. Tumor resection was performed with the transaxillary approach. Though dense granulation tissue obscured normal brachial plexus nerve anatomy, using the surgical microscope and nerve stimulator, grossly total tumor resection was performed. She is free of any neurologic symptom at three months postoperatively.

Endoscopic Transaxillary Silicone Implant Insertion for the Aesthetic Correction of Pectus Excavatum

Scars on anterior chest after operative correction of funnel chest have been the challenging problem despite introduction of refined techiniques by numerous authors. From December 1996 to September 1998, the authors have performed prefabricated silicone implant insertion in eight female patients presenting funnel chest, using transaxillary approaches instead of substernal or inframammary incisions. In two of eight patients, augmentation mammaplasty was performed simultaneously. Except one case of seroma occurred in early stages, all eight cases of pectus excavatum were satisfactorily reconstructed by this technique. All eight patients expressed their satisfaction with the results during the follow-up visits made between 3 months and 3 years. In conclusion, endoscopic transaxillary approach for the scarless anterior chest can be useful technique in aesthetic correction of the funnel chest.