Effect evaluation of gasless endoscopic thyroidectomy <i>via</i> axillary posterior approach forunilateral papillary thyroid microcarcinoma_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

LIU Yan , TIAN Zhilong , GAO Xinbao , YUAN Fukang , GENG Houfa ,  JIA Gaolei

Department of Vascular Thyroid Hernia Surgery, Xuzhou Central Hospital, Xuzhou, Jiangsu 221006, P. R. China;

Corresponding author：

JIA Gaolei, Email: zxyyjgl@163.com

Keywords：

endoscope; axillary posterior approach; papillary thyroid microcarcinoma; cosmetic satisfaction

DOI：

10.7507/1007-9424.202204012

Video：

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Objective To explore the therapeutic effect of gasless endoscopic thyroidectomy via axillary posterior approach for unilateral papillary thyroid microcarcinoma. Methods The clinicopathologic data of patients with unilateral papillary thyroid microcarcinoma who were treated by gasless endoscopic thyroidectomy via axillary posterior approach (observation group) or breast approach (control group) in the Xuzhou Central Hospital from January 2020 to February 2022 were collected. The operation time, accidental intraoperative bleeding, exposure time of recurrent laryngeal nerve, number of lymph node dissection, total hospital stay, and postoperative complications such as superior laryngeal nerve injury, cough due to drinking, temporary hoarseness, transient hypocalcemia, tunnel hematoma, and neck discomfort were compared between the two groups. Meanwhile, the cosmetic effects of the two groups were evaluated. Results A total of 87 patients who met the study conditions were enrolled in this study, including 47 cases in the observation group and 40 cases in the control group. There were no statistical differences in the baseline data such as gende, age, maximum tumor diameter, location of tumor, etc. between the two groups (P>0.05). Compared with the control group, the exposure time of recurrent laryngeal nerve was shorter (P<0.001) and the number of lymph node dissection was more (P=0.034), but the accidental intraoperative bleeding during operation was more (P=0.015) in the observation group. There were no statistical differences in the operation time and total hospital stay between the two groups (P>0.05). There were no superior laryngeal nerve injury and cough due to drinking in the two groups after operation, and there were no statistical differences between the two groups in the terms of postoperative temporary hoarseness, transient hypocalcemia, and tunnel hematoma (P>0.05), but it was found that the incidence of postoperative neck discomfort in the observation group was lower than that in the control group (P=0.043), and the postoperative cosmetic satisfaction score was also higher than that in the control group (P<0.001). Conclusions From the results of this study, gasless endoscopic thyroidectomy via axillary posterior approach for unilateral papillary thyroid microcarcinoma is safe and feasible. It can quickly expose the recurrent laryngeal nerve and greatly improve the efficiency of lymph node dissection, as well as the cosmetic effect is better.

Citation： LIU Yan, TIAN Zhilong, GAO Xinbao, YUAN Fukang, GENG Houfa, JIA Gaolei. Effect evaluation of gasless endoscopic thyroidectomy via axillary posterior approach forunilateral papillary thyroid microcarcinoma. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2022, 29(11): 1463-1467. doi: 10.7507/1007-9424.202204012 Copy

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2.	刘溦薇, 周鸣, 赵吉, 等. 腔镜甲状腺手术与传统甲状腺手术后的并发症比较. 中国普外基础与临床杂志, 2018, 25(3): 323-327.
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6.	郑传铭, 徐加杰, 蒋烈浩, 等. 无充气腋窝入路完全腔镜下甲状腺叶切除的方法—葛-郑氏七步法. 中国普通外科杂志, 2019, 28(11): 1336-1341.
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8.	Qu R, Li J, Yang J, et al. Treatment of differentiated thyroid cancer: can endoscopic thyroidectomy via a chest-breast approach achieve similar therapeutic effects as open surgery? Surg Endosc, 2018, 32(12): 4749-4756.
9.	黄海, 陈欣欣, 马宇园, 等. 无充气腋窝入路完全腔镜下甲状腺癌根治术的学习曲线分析. 中国普通外科杂志, 2021, 30(5): 522-530.
10.	傅锦波, 罗晔哲, 洪晓泉, 等. 经腋窝入路与经胸乳入路腔镜甲状腺切除术的对比研究. 中国微创外科杂志, 2017, 17(8): 688-690.
11.	王艺超, 游薇, 赵婉君, 等. 经口腔前庭入路腔镜甲状腺切除术的研究进展. 中国普外基础与临床杂志, 2020, 27(2): 221-225.
12.	王晓明, 张文新, 张攀攀, 等. 经腋窝入路无充气腔镜甲状腺手术10例临床效果观察. 肿瘤学杂志, 2021, 27(5): 416-419.
13.	郑传铭, 徐加杰, 王佳峰, 等. 无充气腋窝入路腔镜甲状腺手术的进展与展望. 中国普外基础与临床杂志, 2021, 28(10): 1266-1269.
14.	葛军娜, 魏志刚, 孙百慧, 等. 无充气腋窝入路内镜甲状腺系膜切除术. 中国实用外科杂志, 2021, 41(12): 1434-1436.
15.	仇明. 微创手术切除甲状腺及甲状旁腺病灶的关键技术. 外科理论与实践, 2009, 14(4): 385-388.

1. Xia C, Dong X, Li H, et al. Cancer statistics in China and United States, 2022: profiles, trends, and determinants. Chin Med J (Engl). 2022, 135(5): 584-590.
2. 刘溦薇, 周鸣, 赵吉, 等. 腔镜甲状腺手术与传统甲状腺手术后的并发症比较. 中国普外基础与临床杂志, 2018, 25(3): 323-327.
3. Ikeda Y, Takami H, Sasaki Y, et al. Endoscopic resection of thyroid tumors by the axillary approach. J Cardiovasc Surg (Torino), 2000, 41(5): 791-792.
4. Yoon JH, Park CH, Chung WY. Gasless endoscopic thyroidectomy via an axillary approach: experience of 30 cases. Surg Laparosc Endosc Percutan Tech, 2006, 16(4): 226-231.
5. Berber E, Bernet V, Fahey TJ, et al. American Thyroid Association Statement on remote-access thyroid surgery. Thyroid, 2016, 26(3): 331-337.
6. 郑传铭, 徐加杰, 蒋烈浩, 等. 无充气腋窝入路完全腔镜下甲状腺叶切除的方法—葛-郑氏七步法. 中国普通外科杂志, 2019, 28(11): 1336-1341.
7. Luo JH, Xiang C, Wang P, et al. The learning curve for transoral endoscopic thyroid surgery: a single surgeon’s 204 case experience. J Laparoendosc Adv Surg Tech A, 2020, 30(2): 163-169.
8. Qu R, Li J, Yang J, et al. Treatment of differentiated thyroid cancer: can endoscopic thyroidectomy via a chest-breast approach achieve similar therapeutic effects as open surgery? Surg Endosc, 2018, 32(12): 4749-4756.
9. 黄海, 陈欣欣, 马宇园, 等. 无充气腋窝入路完全腔镜下甲状腺癌根治术的学习曲线分析. 中国普通外科杂志, 2021, 30(5): 522-530.
10. 傅锦波, 罗晔哲, 洪晓泉, 等. 经腋窝入路与经胸乳入路腔镜甲状腺切除术的对比研究. 中国微创外科杂志, 2017, 17(8): 688-690.
11. 王艺超, 游薇, 赵婉君, 等. 经口腔前庭入路腔镜甲状腺切除术的研究进展. 中国普外基础与临床杂志, 2020, 27(2): 221-225.
12. 王晓明, 张文新, 张攀攀, 等. 经腋窝入路无充气腔镜甲状腺手术10例临床效果观察. 肿瘤学杂志, 2021, 27(5): 416-419.
13. 郑传铭, 徐加杰, 王佳峰, 等. 无充气腋窝入路腔镜甲状腺手术的进展与展望. 中国普外基础与临床杂志, 2021, 28(10): 1266-1269.
14. 葛军娜, 魏志刚, 孙百慧, 等. 无充气腋窝入路内镜甲状腺系膜切除术. 中国实用外科杂志, 2021, 41(12): 1434-1436.
15. 仇明. 微创手术切除甲状腺及甲状旁腺病灶的关键技术. 外科理论与实践, 2009, 14(4): 385-388.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Effect evaluation of gasless endoscopic thyroidectomy via axillary posterior approach forunilateral papillary thyroid microcarcinoma

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