The operation feasibitity,the key technique difficulities and its managements of endoscopy in thyroid surgery

Objective To investigate the operation feasibitity,the key technique difficulities and its managements in 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 between 10.2006 and 7.2008.Problems on the safety indication contraindications,the key technique difficulties and it management were discussed.Results Of 128 cases,Operations was successfully performed in 122 cases including 20 cases of adenoma enucleation,51 cases of unilateral near subtotal lobectomy,39 cases of bilateral near subtotal lobectomy,and 12 cases of bilateral subtotal lobectomy,6 cases was converted to conventional thyroidectomy because of 4 case hemorrhage and 2 cases large thyroid gland.The operation time was 48-240min(mean 85min),and the intraoperative averagement blood loss was 15 ml.The drainage tubes were removed 3 days and discharge from the hospital 4 days after operation.the postoperation complication include fat liquefaction in 6 cases,subcutaneous emphysema in 2 cases,the neck region ecchymosis in 2 cases,jugular hypesthesia in 2 cases.discomfort at swallowing in 3 cases.There was no other complication such as postoperative bleeding,the hoarse,the injury of the recurrent laryngeal nerve and parathyroid.Follow up for 6-9 months(mean:6 months) in 122 cases found no recurrence,All patients were satisficed with the cosmetic results.Conclusions Thyroidectomy gives little blood loss,mild postoperative pain,little complication satisfactory cosmetic effect with no scars in the neck region being a feasible and safe procedure.The key technique of operation is to keep the adequate handling space,the clear exposure of the thyroid gland,management of the bleeding,estimation of the thyroid gland residual quanlity and corrective techniques suture of the anterior cervical muscles.