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

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.	劉溦薇, 周鳴, 趙吉, 等. 腔鏡甲狀腺手術與傳統甲狀腺手術后的并發癥比較. 中國普外基礎與臨床雜志, 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.	鄭傳銘, 徐加杰, 蔣烈浩, 等. 無充氣腋窩入路完全腔鏡下甲狀腺葉切除的方法—葛-鄭氏七步法. 中國普通外科雜志, 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.	黃海, 陳欣欣, 馬宇園, 等. 無充氣腋窩入路完全腔鏡下甲狀腺癌根治術的學習曲線分析. 中國普通外科雜志, 2021, 30(5): 522-530.
10.	傅錦波, 羅曄哲, 洪曉泉, 等. 經腋窩入路與經胸乳入路腔鏡甲狀腺切除術的對比研究. 中國微創外科雜志, 2017, 17(8): 688-690.
11.	王藝超, 游薇, 趙婉君, 等. 經口腔前庭入路腔鏡甲狀腺切除術的研究進展. 中國普外基礎與臨床雜志, 2020, 27(2): 221-225.
12.	王曉明, 張文新, 張攀攀, 等. 經腋窩入路無充氣腔鏡甲狀腺手術10例臨床效果觀察. 腫瘤學雜志, 2021, 27(5): 416-419.
13.	鄭傳銘, 徐加杰, 王佳峰, 等. 無充氣腋窩入路腔鏡甲狀腺手術的進展與展望. 中國普外基礎與臨床雜志, 2021, 28(10): 1266-1269.
14.	葛軍娜, 魏志剛, 孫百慧, 等. 無充氣腋窩入路內鏡甲狀腺系膜切除術. 中國實用外科雜志, 2021, 41(12): 1434-1436.
15.	仇明. 微創手術切除甲狀腺及甲狀旁腺病灶的關鍵技術. 外科理論與實踐, 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. 劉溦薇, 周鳴, 趙吉, 等. 腔鏡甲狀腺手術與傳統甲狀腺手術后的并發癥比較. 中國普外基礎與臨床雜志, 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. 鄭傳銘, 徐加杰, 蔣烈浩, 等. 無充氣腋窩入路完全腔鏡下甲狀腺葉切除的方法—葛-鄭氏七步法. 中國普通外科雜志, 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. 黃海, 陳欣欣, 馬宇園, 等. 無充氣腋窩入路完全腔鏡下甲狀腺癌根治術的學習曲線分析. 中國普通外科雜志, 2021, 30(5): 522-530.
10. 傅錦波, 羅曄哲, 洪曉泉, 等. 經腋窩入路與經胸乳入路腔鏡甲狀腺切除術的對比研究. 中國微創外科雜志, 2017, 17(8): 688-690.
11. 王藝超, 游薇, 趙婉君, 等. 經口腔前庭入路腔鏡甲狀腺切除術的研究進展. 中國普外基礎與臨床雜志, 2020, 27(2): 221-225.
12. 王曉明, 張文新, 張攀攀, 等. 經腋窩入路無充氣腔鏡甲狀腺手術10例臨床效果觀察. 腫瘤學雜志, 2021, 27(5): 416-419.
13. 鄭傳銘, 徐加杰, 王佳峰, 等. 無充氣腋窩入路腔鏡甲狀腺手術的進展與展望. 中國普外基礎與臨床雜志, 2021, 28(10): 1266-1269.
14. 葛軍娜, 魏志剛, 孫百慧, 等. 無充氣腋窩入路內鏡甲狀腺系膜切除術. 中國實用外科雜志, 2021, 41(12): 1434-1436.
15. 仇明. 微創手術切除甲狀腺及甲狀旁腺病灶的關鍵技術. 外科理論與實踐, 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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