Endoscopic thyroidectomy via chest and breasts approach with 500 cases

Objective To discuss the method,the safety,the advantages and disadvantages of endoscopic thyroidectomy via chest and breasts.Methods From Mar.2002 to Dec.2006,Endoscopic thyroidectomy via anterior chest and breast approach was performed in 500 patients,including 74 cases of Grave's disease(1 case has an opened operation history),111 cases of thyroid adenoma,293 cases of nodular goiter(10 cases have 1～2opened thyroidectomy history,2 cases secondary of hyperthyroidism),and 22 cases of thyroid carcinoma.Results The endoscopic thyroidectomy was successfully carried out in 492 cases,including tumor dissection in 50 cases,one lobe partial thyroidectomy in 214 cases,subtotal thyroidectomy in 212 cases(including 73 cases of Graves' disease),and radical thyroidectomy in 16 cases of thyroid carcinoma.The operative time length ranged from 40 to 270 min(mean 74.5 min).Mean operative blood loss was 5.5(3～250)ml,no cases underwent blood transfusion.The drawing tube was pulled out during 2 to 3 days postoperation.Postoperative hospital stay ranged from 3 to 8 days(mean 4.2 days).There were some compllications such as subcutaneous bleeding(3 cases,one case need a reoperation by endoscopic),burn of the aderma(1 case),inflammation of the incision(2 cases),subcutaneous bruising(3 cases),subcutaneous effusion(6 cases),and temporarily damage of the recurrent laryngeal of 2 cases.There were no complications such as damage to recurrent laryngeal nerve or parathyroid glands.The complication rate is 3.5%.The hospital charges ranged from 7600 to 13 500 yuan(mean 10 510 yuan,the mean hospital charges of open thyroidecotmy patiens of the same term is 6700 yuan).The post-operative following-up for 3 to 57 months indicated that all the patients were satisfied with the cosmetic results and the same curative effects as conventional surgery were obtained.However,3 cases of nodular goiter,1 case of thyroid carcinoma,and 1 case of Grave's disease were recurrented.The operations were converted into open surgery in 8 cases.The 22 carcinoma cases are still living.Conclusions Endoscopic thyroidectomy is a safe and effective method of thyroid surgery.Since all the minimal incisions are on concealed parts of the body,the obvious cosmetic effect of this method is guaranteed.Some disadvantages such as complications and more high costs are needed to be overcome.