Endoscopic Completion Thyroidectomy by the Bilateral Axillo-Breast Approach

Abstract

Purpose: Bilateral axillo-breast approach (BABA) endoscopic thyroidectomy has been successfully used for various thyroid diseases, with an excellent cosmetic outcome. Patients with a confirmed thyroid malignancy on a permanent thyroid section after endoscopic thyroid lobectomy require completion thyroidectomy. Here, we sought to demonstrate the feasibility of endoscopic completion thyroidectomy by BABA. Patients and Methods: Between June, 2006 and February, 2009, 13 patients underwent endoscopic completion thyroidectomy by BABA for minimally invasive follicular thyroid and papillary thyroid carcinomas diagnosed after BABA endoscopic thyroid lobectomy. The median interval between thyroid lobectomy and completion thyroidectomy was 5.6 months (range, 4.2-28.2 mo). We used the same port sites (bilateral breast and axillary region) as were created at the initial operation. Flap adhesion was minimal. After identifying the remnant thyroid lobe, completion thyroidectomy was performed under full visualization of the thyroidal vessels, parathyroid glands, and recurrent laryngeal nerve. Results: We performed 5 right and 8 left endoscopic completion thyroidectomies by BABA. The mean operation time was 109.3 +/- 23.3 minutes. There were no cases of open conversion. The resulting 6 (46.2%) cases of transient hypocalcemia resolved within 2 postoperative weeks and there were no cases of vocal cord palsy or wound infection. One patient had immediate postoperative breast flap bleeding that required cauterization. No patient had evidence of recurrence, as indicated by follow-up neck ultrasonography and serum thyroglobulin levels. The cosmetic outcomes were excellent and all patients were satisfied. Conclusions: BABA endoscopic thyroidectomy appears feasible and safe procedure for completion thyroidectomy, making it a viable technique for reapplication in cases of thyroid carcinoma diagnosed after endoscopic thyroid lobectomy.