Endoscopic Thyroidectomy of the Differentiated Thyroid Cancer

ABSTRACT

PURPOSE: Endoscopic neck surgery has a smaller wound size and enables the positions of the wounds to be moved to places of cosmetic benefit. Therefore, it is strongly preferred by many patients, especially women. We applied this technique to the treatment of thyroid cancer. METHODS: An endoscopic thyroidectomy was performed on 17 female thyroid cancer patients with a mean age 35 years in our Department from January 1999 to January 2003. The selection criteria were a tumor size < or =2 cm, no thyroiditis, no previous neck surgery or irradiation, no lymphadenopathy on a preoperative imaging study. The preoperative or intraoperative diagnoses of these patients included 13 papillary cancers and 4 follicular cancers. The procedure was performed using the anterior chest approach with CO2 gas insufflation. RESULTS: Fourteen hemithyroidectomies and three total thyroidectomies were successfully performed. The mean operative time was 84.2+/-20.9 min for the 14 hemithyroidectomies and 148.3+/-32.5 min for the 3 total thyroidectomies. There was no conversion to conventional surgery. The mean tumor size was 1.6 cm (0.8~2.7) The mean hospital stay was 8.9 days. All the patients were satisfied with the cosmetic result except for one patient who underwent a conventional salvage operation due to an involved surgical margin on a permanent section. The postoperative complications included one case of transient recurrent nerve palsy and one case of transient symptomatic hypocalcemia. The mean follow up period was 30 months(13~59). One patient after a total thyroidectomy had a paratracheal lymph node metastasis on the thyroid scan 2 years after surgery and received 131I radioablation. CONCLUSION: With the advent of preoperative imaging study, an endoscopic thyroidectomy for thyroid cancer is feasible and safe in properly selected patients. In addition, this procedure has a better cosmetic outcome than conventional open surgery.