The axillary access in unilateral thyroid resection

Abstract

This study shows that endoscopic thyroid surgery approximates the norms of endocrine neck surgery. The presented method is useful in thyroid surgery for patients with single nodules and a small thyroid gland.

Monitoring of the Recurrent Laryngeal Nerve in Totally Endoscopic Thyroid Surgery

“…The majority of the authors reporting on endoscopic thyroidectomy call for an intraoperative identification of this nerve [1,3,8,16,17,19,23] due to the fact that postoperative RLN palsy is one of the largest problems in thyroid surgery. Dralle et al [1] reported that it is followed by an enormous economic and health care burden, an increasing number of medicolegal proceedings and a significant disruption of socioeconomic outcome for the afflicted patients.…”

“…Since then, quite a number of similar reports have been published, all of them describing an access outside the front neck region. Such accesses are the lateral neck [11] , chest [12,13] , axillary [14][15][16] , a combined axillary bilateral breast [17][18][19] or a bilateral axillary breast approach [20] . It is the aim of such procedures to achieve an optimal cosmetic result while keeping the access trauma acceptable [21,22] .…”

“…A review of 8 papers dealing with totally endoscopic thyroid surgery showed that in all patients, the RLN was identified ( table 1 ). However, a neuromonitoring system was used by only 1 author [16] . In this study with 12 patients who were operated on using the axillary access [16] , the neuromonitoring system was proved to be helpful.…”

“…However, a neuromonitoring system was used by only 1 author [16] . In this study with 12 patients who were operated on using the axillary access [16] , the neuromonitoring system was proved to be helpful. Ikeda et al [21] compared patients with endoscopic thyroidectomy and patients with conventional open thyroidectomy.…”

Transorale partielle Parathyreoidektomie

“…Hierzu gehören beispielsweise der dorsale Zugang am Hals, der thorakale, axilläre oder der kombinierte bilaterale inframammäre und axilläre Zugang. Hierdurch soll ein optimales kosmetisches Ergebnis erreicht und das Zugangstrauma so gering wie möglich gehalten werden [9,10,11,12,13,14,15]. Allerdings stehen einige der sogenannten minimal-invasiven Verfahren wie beispielsweise der axilläre oder inframammäre Zugang zur Schilddrüsenloge aufgrund des ausgeprägten Gewebetraumas im Bereich des Zugangsweges und der lagen Operationszeiten in der Kritik [16,17].…”