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논문 상세정보

양성 갑상선결절에서의 일측 액와-유방접근법을 이용한 무기하 내시경 반갑상선절제술:새로운 접근법에 대한 예비결과

Endoscopic Hemithyroidectomy via a Unilateral Axillo-Breast Approach without Gas Insufflation in Unilateral Benign Thyroid Lesions:Preliminary Results of a Novel Approach

대한이비인후-두경부외과학회지 v.51 no.9 , 2008년, pp.805 - 811  
김재욱, 이승원, 이경수, 황규린, 고윤우

Although the usefulness of various endoscopic thyroid surgery techniques has been reviewed,little specific information is available regarding ENT surgeons who maybe unfamiliar with laparoscopic surgery and must performingendoscopic thyroidectomy. We examined the feasibility and safety of endoscopic thyroid surgery via a novel approachwithout gas insufflation. Subjects and Method:Forty-one patients undergoing endoscopic hemithyroidectomy via a unilateralaxillo-breast approach without gas insufflation were enrolled in this study. Our indications for endoscopic thyroid surgery wereas follows:1) benign nodules less than 6 cm in diameter, 2) follicular neoplasm less than 6 cm in diameter, and 3) only unilateralthyroid lesions. The following variables were examined:perioperative complications, operation time, diameter of resectedthyroid nodule, permanent pathology, time of hospital discharge after operation, duration of drain placement, and total amount ofdrainage. Results:Postoperative pathology revealed 8 follicular adenomas, 31 nodular hyperplasias, and 2 lymphocytic thyroiditis.The operating time in the first 10 hemithyroidectomies was 154.0±64.88 min, which was 38.07 min longer than in thelast 31 hemithyroidectomies (115.93±32.64 min;p=0.1426). The amount and duration of postoperative drainage were 249.34±118.47 mL in 4.01±1.31 days, respectively. The postoperative hospital stay was 6.12±1.99 days. Overall, perioperative complicationsoccurred in seven patients (7/41, 17.1%), including one transient recurrent laryngeal nerve palsies (2.4%), five seromas(12.2%), and one hematoma (2.4%), which arose from a subplatysmal skin flap. Conclusion:These results suggest that endoscopichemithyroidectomy via a unilateral axillo-breast approach without gas insufflation is safe and effective in selective unilateralbenign thyroid lesions and appears to provide better cosmetic results and a shorter operation time than other endoscopicthyroidectomy methods. However, more invasiveness due to significant dissection aimed at obtaining an adequate workingspace and longer operation time needed than with either traditional open surgery or the minimally invasive video assisted techniqueshould be overcome through accumulation of experience. (Korean J Otorhinolaryngol-Head Neck Surg 2008;51:805-11)

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