Hybrid-type endoscopic thyroidectomy (HET: Tori’s method) for differentiated thyroid carcinoma including invasion to the trachea

Abstract

BackgroundEndoscopic thyroidectomy (ET) or robotic thyroidectomy is yet to be applied to thyroid carcinoma invasive to the trachea and to wide lymph node node metastasis. On the other hand, small-incision thyroidectomy lacks sufficient working space and clear vision. The author has newly developed hybrid-type endoscopic thyroidectomy (HET) to overcome these problems.MethodsFrom March 2011 to February 2012, HET was performed for 85 patients. Clinicopathologic characteristics were analyzed. To evaluate the superiority of HET for malignancy representatively, conventional lobectomy with central compartment node dissection (CCND) performed 1 year previously was compared with HET. In lobectomy and node dissection, a single skin incision (1.5 cm) is made above the clavicle, with a port incision (5 mm) made 3 cm below the clavicle. Then CCND is performed directly through the incision by lifting up the isthmus. To obtain sufficient working space for the lobectomy, the strap muscles are taped and pulled toward the head, then hung by the cradle. The thyroid lobe is retracted to the midline with a retractor, followed by isolation of the inferior laryngeal nerve and transection of the inferior thyroid vessels with the monitor of the scope. Lateral lymph nodes dissection can be performed at the same time, if necessary. In total thyroidectomy, the same procedure is performed at the opposite side. The scalpel can be used to shave through each incision in case of tracheal invasion.ResultsOf the 85 cases, 62 were malignant, involving papillary thyroid carcinoma (PTC), and 23 were benign. Total thyroidectomy was performed for 22 of the PTC cases and CCND for 49 of the cases. Shaving for tracheal invasion was performed for eight patients. No mortality, complications, recurrence, or metastasis was found 1–2 years after the operation. Compared with conventional thyroidectomy, HET was superior in blood loss, visual analog scale, and postoperative hospital stay.ConclusionThe author’s method (Tori’s method) might be less invasive, cosmetically excellent, and moreover, safe and feasible for differentiated thyroid carcinoma including invasion to the trachea.

Novel operative approach to double primary cancers of the breast and thyroid and its effects on cosmesis and the accuracy of follow‐up examinations

“…Our new approach, HET, certifies the curability and safety of thyroid surgery during the perioperative course , and the scars do not affect the mammary glands. The combination of cosmetic surgery for double primary cancers of the breast and thyroid has not previously been reported in the literature.…”

“…Therefore, for the first time, we report a novel endoscopic procedure for TC: hybrid‐type endoscopic thyroidectomy (HET) in combination with breast surgery. This procedure offers both excellent cosmesis and curability after surgery for double primary cancers .…”

Lateral approach contributes to shortened surgical time in video-assisted neck surgery (VANS) for thyroid nodule

“…Collar incision over 5 cm is required in the neck for open thyroid surgery. Since Hüscher et al reported endoscopic right thyroid lobectomy from the right clavicle using low-pressure CO 2 insufflation in 1997 [ 1 ], various approaches including axilla, breast, postauricular, and oral methods have been tried, aiming to improve/resolve cosmetic problems [ [2] , [3] , [4] , [5] , [6] , [7] , [8] ].…”

Minimal transcervical access single-port endoscopy-assisted thyroidectomy: a retrospective comparative study.

“…MINET is a thyroidectomy performed without an endoscope using an incision of no more than 3.5 cm [ 5 , 6 ]. It has deficiencies of a narrow operative window and difficult dissection of the recurrent laryngeal nerve owing to a limited visual view [ 9 , 10 ]. MIVAT with mechanical retraction pioneered by Miccoli was initially done with an incision of about 1.5 cm [ 11 ].…”