액와접근법과 흉부접근법을 통한 내시경 갑상선 절제술의 임상적 고찰

A Clinical Analysis of Endoscopic Thyroidectomy by the Axillary and Anterior Chest Approach

Purpose: The thyroid suregry has recently become one of the newest fields for the application of endoscopic surgery. We have performed endoscopic thyroidectomy by an anterior chest approach and an axillary approach. In this study, we evaluated these two types of endoscopic procedures with regard to efficacy and patients' complaints after surgery.Methods: Between December 2000 and March 2002, 41 patients were treated by endoscopic thyroidectomy via axillary or anterior chest approach. Each procedure was performed by one surgeon under a general anesthesia. We analysed the operating time, postoperative complications, postoperative scar, the degree of pain to assess the surgical invasiveness of each procedure.Results: Three cases treated using anterior chest approach, and 2 cases treated using axillary approach were converted to conventional thyroidectomy. The mean age of patients was 36 years in anterior chest approach group and 30 years in axillary approach group. The operation time was 238⁑60 (160∼370) minutes in anterior chest approach and 178⁑71 (100∼295) minutes in axillary approach. Postoperative complications are; 1 case of a minimal hematoma, 3 cases of minor wound infection, 3 cases of chest pain in anterior chest approach group, and 1 case of a minimal hematoma, 1 case of transient recurrent laryngeal nerve injury, 1 cases of transient swallowing difficulties in axillary approach group.Conclusion: Endoscopic (gasless and axillary approach) thyroidectomy is a safe and effective procedure. Gasless endoscopic thyroidectomy is a useful procedure for unexperienced surgeon due to safety. Endoscopic thyroidectomy by the axillary approach is a better effective procedure with good cosmetic result for a unilateral tumor especially in young women. (Korean J Endocrine Surg 2003;4:26-30)