Endoscopic Thyroid Surgeries via Areola Approach: Experience and Outcomes of 500 Cases in a Single Institute

Endoscopic Left Central Lymph Node Dissection of Thyroid Cancer: Safe, Feasible, and Relatively Easy

Purpose. The purpose of this study was to explore the feasibility of left central lymph node dissection (CLND) in endoscopic thyroidectomy via chest-breast approach (ETCB). Methods. Retrospective analysis of 57 cases of left CLND (group A) via ETCB, 35 cases of open left CLND (group B), and 90 cases of right CLND via ETCB (Group C) were performed from October 2014 to October 2019. Surgical data, complications, and follow-up data were compared among group A and group B, group A and group C, respectively. Results. There were no significant differences between group A and group B in intraoperative blood loss, tumor size, lymph node (LN) metastasis rate, dissected LN number, metastatic LN number, serum thyroglobulin (sTg), radioactive iodine uptake (RAIU), radioactive technetium uptake (RATU), radionuclide imaging of the residual area (RITRA), and radionuclide imaging of suspicious lymph node metastasis (RISLNM). There were no significant differences between group A and group C in age, operation time, intraoperative blood loss, postoperative hospital stay, tumor size, LN metastasis rate, dissected LN number, metastatic LN number, hypoparathyroidism, sTg, RAIU, RATU, RITRA, and RISLNM. There were 5 cases of temporary recurrent laryngeal nerve (RLN) palsy and 1 case of recurrence in group C. Besides, 1 case of lymphatic leakage was in group A. Conclusion. For selected cases, endoscopic left CLND is safe, feasible, efficient, and more easier than endoscopic right CLND.

Right Central Lymph Node Dissection in Thyroidectomy: Can Endoscopic Chest-Breast Approach Be Used?

Background: The purpose of this research was to investigate the feasibility and strategies of right central lymph node dissection (CLND) in endoscopic thyroidectomy through chest-breast approach. Materials and Methods: Retrospective analysis on the conduction of 68 cases of endoscopic thyroidectomy through chest-breast approach with right side CLND (endoscopic group) and 31 cases of thyroidectomy through low-neck collar cervical approach with right side CLND (open group) from July 2014 to February 2019. The intraoperative and postoperative data were compared between the two groups. Results: All the surgeries in open group were successfully completed as well as the endoscopic group without any intraoperative conversion into open surgery. There were no difference in sizes of tumor, incidence of lymph node metastasis, number of dissected and metastatic lymph nodes, and postoperative hospitalization days between the two groups. Temporal hypoparathyroidism occurred in both groups with endoscopic group to be 24 cases and open group to be 15 cases but no case in both groups suffering from permanent hypoparathyroidism, recurrent laryngeal nerve injury, lymphatic leakage, or death. One case in endoscopic group was treated with secondary surgery for lateral cervical lymph node metastasis and no evidence of recurrence or metastasis was found in other cases during postoperative follow-up. Conclusions: With strict control in surgical indications and contraindications, endoscopic surgery is safe and feasible for selected cases with the same effect as open surgery on dissection of lymph nodes in the right central region, which is in line with the principle of radical treatment of tumors.

The Transareola Endoscopic Approach Yields Adequate Oncological Dissection as Open Approach in the Treatment of Papillary Thyroid Carcinoma

OBJECTIVE

This study aimed to evaluate and discuss whether the transareola endoscopic surgery has similar outcome outcomes to open surgery in the treatment of papillary thyroid carcinoma (PTC).

METHOD

A total of 102 patients with PTC were enrolled in this study. Among them, 53 patients were treated by transareola endoscopic surgery (endoscopic group) and 49 patients were treated by open surgery (open group). Some specific factors, including thyroglobulin (Tg), radioactive iodine uptake (RAIU), postoperative nuclide imaging in thyroid area, postoperative nuclide imaging of lymph nodes suspicious for metastasis (PNILNSM), etc. were analyzed and compared between the 2 groups.

RESULTS

There were no significant differences between the 2 groups regarding body mass index (22.9±3.4 vs. 24.0±3.3, P=0.103), operation time (173.3±43.2 vs. 158.8±47.9 min, P=0.110), intraoperative blood loss (41.8±19.4 vs. 35.8±31.0 mL, P=0.251, P=0.251), tumor diameter (19.0±6.8 vs. 20.2±7.2 mm, P=0.400), and overall complications (11.3% vs. 10.2%, P=0.868). No significant difference was found in the specific factors between the 2 groups concerning RAIU-2h/24h (2.44±1.34 vs. 2.58±1.65%/2.83±3.75 vs. 2.35±3.44%, P=0.646/ P=0.506), number of dissected lymph nodes (4.4±1.4 vs. 4.6±1.5, P=0.595), Tg before radioiodine therapy (4.46±5.50 vs. 5.60±8.36; P=0.495), Tg after radioiodine therapy (1.03±1.93 vs. 1.11±1.61, P=0.812, P=0.812), postoperative nuclide imaging in thyroid area (1.76±1.50 vs. 2.19±1.85 cm, P=0.195), PNILNSM before radioiodine (none: 79.2% vs. 83.7%, P=0.566; central: 17.0% vs. 12.2%, P=0.653; lateral: 1.9% vs. 4.1%, P=0.450; central+lateral: 1.9% vs. 0%, P=1.000), and PNILNSM after radioiodine (none: 94.3% vs. 95.9%, P=0.111; central: 3.8% vs. 2.0%, P=1.000; lateral: 0 vs. 2.0%, P=0.480; central+lateral: 1.9% vs. 0%, P=1.000).

CONCLUSIONS

Transareola endoscopic total thyroidectomy and central lymph nodes dissection are safe and effective. According to the evaluated postoperative specific factors, this technique achieves similar outcomes to open surgery in selected patients with PTC.

Technique for endoscopic thyroidectomy with selective lateral neck dissection via a chest-breast approach

BACKGROUND

Endoscopic thyroidectomy has been widely accepted because it can effectively avoid neck scarring. However, there are seldom reports concerning completely endoscopic lateral neck dissection approaches. In this study, we introduced a technique for performing endoscopic thyroidectomy with lateral neck dissection via a chest-breast approach.

METHODS

We retrospectively reviewed 18 patients who underwent endoscopic total thyroidectomy along with levels II, III, IV, and VI dissection. All major outcomes, such as cosmetic effect, operative time and complications, etc., were analyzed. In addition, another 20 patients who underwent traditional open surgery (open group) were enrolled in the study to conduct a contrasting analysis between patients treated with the endoscopic technique (endoscopic group) and open group patients, in terms of demographic data and main operative outcomes, to evaluate the feasibility of this technique.

RESULTS

All 18 endoscopic surgery cases were successfully performed, and no patient was converted to the open procedure intra-operatively. There were no significant differences between the two groups regarding age (P = 0.209), Body Mass Index (P = 0.479), sex (P = 0.218), drainage time (P = 0.153), operation time (P = 0.065), intra-operative blood loss (P = 0.139), post-operative pain (P = 0.114), and number of dissected lateral lymph nodes (II: P = 0.201; III + IV: P = 0.107). The mean total and lateral lymph nodes dissection (LLND) time in the endoscopic group were longer than those of the open group (P = 0.002; 235 ± 35 vs. 182 ± 20 min, P = 0.000; 125 ± 21 vs. 80 ± 14 min, P = 0.000). The primary lesion diameter of the endoscopic group was smaller than that of the open group (1.7 ± 0.8 vs. 2.9 ± 1.3 cm, P = 0.002). The scores for cosmetic satisfaction in the endoscopic group were higher than those in the open group (8.3 ± 0.7 vs. 4.4 ± 0.9, P = 0.000). Among the complications, there was no significant difference between the two approaches in transient vocal cord paresis (1/18 vs. 0/20, P = 0.474), transient hypoparathyroidism (4/18 vs. 4/20, P = 1.000), post-operative lymphatic leakage (1/18 vs. 3/20, P = 0.606), and intra-operative large blood vessel injury (2/18 vs. 0/20, P = 0.218). There was no incidence of uncontrolled bleeding, mental nerve injury, permanent hypoparathyroidism, permanent recurrent laryngeal nerve (RLN) injury, skin bruise on the neck, asphyxia/dyspnea or other complications like tracheal injury, esophageal injury, etc., nor was there any death or recurrence in either of the two groups during the short follow-up period.

CONCLUSION

It is feasible to perform LLND (levels II, III, IV, and VI) with endoscopic thyroidectomy via a chest-breast approach. In particular, this technique avoids a large scar on the patient's neck and has well operative outcomes compared with open surgery. Accordingly, this technique may offer one more option for selective patients.