The clinical application of endoscopic thyroid surgery without cervical incision

Objective:To investigate the feasibility,key technique difficulties and its solution of endoscopic thyroidectomy through anterior chest and breast approach.Methods:A retrospective analysis was made on the clinical data of 128 cases,who were treated with endoscopic thyroidectomy from Oct.2006 to Jul.2008.And the safety,indication,contraindication,the key technique difficulties and its management of the operation were discussed.Results:Of 128 cases,operations were successfully performed in 122 cases and 6 cases were converted to conventional thyroidectomy because of 4 cases of hemorrhage and 2 cases of large thyroid gland.Besides,the operation time was 48-240min(mean 85min),and the average of intraoperative blood loss was 15ml.Patients got rid of the drainage tubes after 3 postoperative days and were discharged from the hospital after 4 postoperative days.The postoperative complications included subcutaneous hydrops in 6 cases,subcutaneous emphysema in 2 cases,the neck region ecchymosis in 2 cases,jugular hypesthesia in 2 cases,and discomfort at swallowing in 3 cases.All of the patients suffered from complications were treated by symptomatic management and recovered soon.However,there were no other complications such as postoperative bleeding,the hoarse,the injury of the superior laryngeal nerve,recurrent laryngeal nerve and parathyroid gland.And no recurrence was found in 122 cases by following up 6-9 months(mean,6 months),all patients were satisfied with the cosmetic effect of the operation.Conclusions:Endoscopic thyroidectomy leads to little blood loss,mild postoperative pain,little complication,satisfactory cosmetic effect with no scars in the neck region,and is suggested as a feasible and safe procedure.The key technique of operation is to keep the adequate operative space,the clear exposure of the thyroid gland and neoplasm,to manage the bleeding,estimate the residual quantity of thyroid gland,proficient manipulation of ultrasound knife and suture of the anterior cervical muscles.