Endoscopic Thyroidectomy Using the Unilateral Axillo-breast Approach Versus the Modified Anterior Chest Wall Approach: A Prospective Comparative Study

Abstract

Introduction: Endoscopic thyroidectomy (ET) has become a well-established surgical technique that is mainly performed for benign thyroid lesions. Several endoscopic approaches are available, such as transaxillary, unilateral axillo-breast approach (UABA), modified anterior chest wall approach (MACWA), bilateral axillo-breast approach, and most recently the transoral approach and the robotic-assisted techniques. There is no recommended approach, because each approach has its own positive and negative attributes. We, herein, compare between UABA and MACWA in terms of surgical and cosmetic outcomes. Methods: This prospective study was conducted from April 2016 to August 2017. Forty patients with unilateral benign thyroid lesions were selected. Of them, 20 patients underwent ET using UABA, and 20 patients underwent ET using MACWA. Gas insufflation was implemented for all patients. Clinicopathologic data, surgical outcomes, and cosmetic outcomes in both groups were analyzed. Results: There was no significant difference between both groups in the clinicopathologic characteristics. The mean surgical time was significantly longer in the UABA group compared with the chest wall group (147.3 vs. 124.3 min). The postoperative pain scores were relatively lower in the UABA group compared with the MACWA group. We reported a higher rate of persistent paresthesia, neck contracture with swallowing discomfort, and hypertrophic scars in the MACWA group. Cosmetic satisfaction scores for patients who underwent UABA were higher than for those who underwent MACWA. Conclusions: Both approaches were similar in terms of safety, feasibility, and operative complications. Even though the surgical time was longer, patients who underwent the UABA reported relatively less postoperative pain, superior cosmetic results, scar perception, and patient satisfaction compared with MACWA.

Transoral endoscopic thyroidectomy vestibular approach vs conventional open thyroidectomy: Meta‐analysis

“…Conventional open thyroidectomy (COT) has traditionally been accepted as the standard surgery for some thyroid diseases. Due to the noticeable scar on the anterior neck caused by COT and increasingly cosmetic requirements, 1,2 especially in women, a variety of endoscopic thyroidectomy (ET) approaches have been developed, such as subclavian, 3 areola, 4 breast, 5 axillary, 6 axillo‐breast, 7 and dorsal approach 8 . However, concerns were also raised as these approaches may associate with an extensive flap dissection, scar hyperplasia at the incision sites, and difficulties in dissecting the lower part of central lymph node 9,10 .…”

Thyroidectomy-related Swallowing Difficulties: Review of the Literature

“…The surgical techniques may also influence swallowing. Authors who have compared conventional open thyroidectomy to robotic techniques, minimally invasive thyroid surgery, and subfascial approach to the thyroid reported a statistically significant increase of swallowing impairments in the conventional group ( 10 , 11 , 16 , 33 , 37 , 38 , 52 , 53 ). Additionally, laryngopharyngeal reflux (LPR) could influence postsurgical swallowing complaints ( 6 , 13 , 25 , 54 , 55 ).…”

Comparative Study of Gasless Transaxillary, Bilateral Axillo-Breast, Unilateral Axillo-Breast With Carbon Dioxide Insufflation, Retroauricular, and Transoral Vestibular Endoscopic Thyroidectomy Approaches at a Single Institution: A Retrospective Analysis and Lessons Learned

“…1 ). The operative time is shorter, postoperative pain and discomfort are less intense, and the drainage amount is lower because UABA does not involve the elevation of a long and large flap like that in TA [ 22 ]. The operative vision and instrument handling are as excellent as that of TA; therefore, dissection around the upper pole or Berry’s ligament is easy.…”

“…The cosmetic results are good because UABA only leaves two small scars in the axilla and one small scar in the periareolar area. UABA and a modification of UABA using a robot system, called the transaxillary gas-insufflation approach, has been performed at some thyroid centers, with good overall patient satisfaction [ 22 , 23 ].…”