Endoscopic thyroidectomy via axillary-breast-shoulder approach: Early experience of 42 cases.

BACKGROUND: Most patients in Indonesia present with large-sized thyroid nodules, which need surgical removal to exclude malignancy. Many surgeons prefer endoscopic thyroidectomy to avoid a large and visible surgical scar on the neck and to reduce postoperative complications. This study aims to evaluate and analyze surgical feasibility, safety, oncologic outcome, and patient satisfaction of endoscopic thyroidectomy via the axillary-breast-shoulder approach.

METHODS: Between August 2010 and September 2015, 42 endoscopic thyroidectomies via the axillary-breast-shoulder approach with carbon dioxide insufflation up to 8-10 mmHg were performed and retrospectively reviewed.

RESULTS: Mean tumor size and operative time were 3.11 ± 0.99 cm and 189 ± 45 min, respectively. Mean blood loss was 68.3 mL. There were temporary complications such as hoarseness (19%), emphysema (2.3%) and hematoma (2.3%). Mean hospital length of stay was 3.98 days. Most subjects (61.9%) were very satisfied with the postoperative scar. The visual analog score of postoperative pain decreased from 4.83 on day-1 to 2.28 on day-7. The tumor recurrence was 9.6%.

CONCLUSIONS: Endoscopic thyroidectomy via the axillary-breast-shoulder approach is feasible, safe, and minimally invasive with excellent postoperative results.