Endoscopic Subtotal Thyroidectomy for Patients with Graves' Disease

Abstract

Endoscopic thyroidectomy performed via the precordial approach leaves no scarring of the neck, and thus provided excellent results from a cosmetic viewpoint. We applied this technique to perform subtotal thyroidectomy in 12 patients with Graves' disease. Three trocars were inserted in the precordial region, and endoscopic surgery was performed with carbon dioxide insufflation. Vessel management and thyroidectomy were carried out using ultrasonic coagulation devices. The mean operative time was 259.8 min, and the mean blood loss was 90.2ml. There were no postoperative complications such as subcutaneous emphysema or hemorrhage, although hypoparathyroidism and recurrent laryngeal nerve paralysis occurred in one patient. Cosmetically esthetic results were achieved in all patients. These findings indicate that this surgical technique represents an effective method of treating Graves' disease that provides excellent cosmetic results.

Transoral endoscopic thyroidectomy vestibular approach (TOETVA) for Graves’ disease: a comparison of surgical results with open thyroidectomy

“…At present, there is little data on the use of endoscopic or robotic thyroidectomy in Graves' disease patients (15)(16)(17)(18), possibly because of hypervascularity and the large size of the thyroid gland in these patients. Moreover, there is no report for use of the transoral thyroidectomy in Graves' disease patients either.…”

“…Dissection and bleeding control may become difficult due to the relatively small working space and the highly vascular pattern of the gland. This is frequently the reason for conversion to open surgery (15,19). The use of TOETVA has helped to solve this problem because of birds-eye view through the use of magnified stereoscopic visualization and the movement of laparoscopic instruments being superior and improve dexterity and enable more meticulous bleeding control, resulting in a safer surgical procedure (14).…”

“…The enhanced refinement of this transoral thyroidectomy technique was well-established and described by Anuwong as the transoral endoscopic thyroidectomy vestibular approach (TOETVA) with excellent clinical results (14). This successful experience with TOETVA led the authors of this paper to extend the indications for the procedure to include patients with Graves' disease, for which there remains little data concerning the use of endoscopic thyroidectomy approaches (15)(16)(17)(18).…”

Endoscopic Right Lobectomy Axillary-breast Approach: Report of Two Cases

“…After this attempt, Ohgami et al [10] performed endoscopy via breast approach for thyroid adenoma 5-7 cm in diameter. Yamamoto et al [11] applied endoscopy by breast approach for Graves' disease patients. Ikeda et al [12] applied anterior chest and axillary approach for follicular tumors, Graves' disease, and papillary microcarcinoma.…”

Endoscopic Thyroidectomy: Experience of Breast and Axillary Approach

“…The cause of hypocalcaemia and recurrent laryngeal nerve palsy in these patients might be caused by lateral thermal spread by the ultrasonic coagulation devices [20].…”