Total endoscopic thyroidectomy with bilateral breast areola and ipsilateral axillary (BBIA) approach

Endoscopic surgery for thyroid nodules is used by many endocrine surgeons. The present study reviews our experiences with endoscopic thyroidectomy using bilateral breast areola and ipsilateral axillary (BBIA) approach to evaluate its safety and feasibility.

From June 2003 through November 2007, the study group was comprised of 68 consecutive patients with benign thyroid nodules (66 women; mean age, 33.28 +/- 10.3 (range, 15-72) years). A detailed description of the surgical technique is provided.

The mean maximum diameter of the tumor was 3.14 +/- 1.61 (range, 1-10.7) cm. Sixty-five cases were successfully resected with an endoscopic procedure, but three cases were converted to a conventional open procedure due to bleeding. Endoscopic procedures were 61 lobectomies, 2 isthmectomies, and 2 near total thyroidectomies. The mean operating time was 89.93 +/- 24.71 (range, 50-170) minutes, and the last 32 cases tended to take less time than the first 33 cases (P = 0.033). No CO2 gas-related complications, such as subcutaneous emphysema or hypercapnia, were observed. There was no case of permanent recurrent laryngeal nerve injury or hypoparathyroidism. The mean length of the hospital stay was 5.37 +/- 1.5 (range, 3-11) days.

Endoscopic thyroidectomy using BBIA approach is safe and feasible. The cosmetic results were considered excellent by all patients. The advantages of this approach are no cervical or chest wall scar, and no significant morbidity.