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Published on: May 23, 2021
Postauricular and axillary approach endoscopic neck surgery: a new technique
Kyu Eun Lee1, Hoon Yub Kim, Won Seo Park
1Department of Surgery, Seoul National University College of Medicine, and Seoul National University Hospital, 101 Daehangno, Jongno-gu, Seoul, 110-744, Republic of Korea.
World Journal of Surgery
|February 10, 2009
Summary
The postauricular and axillary approach (PAA) offers a viable endoscopic neck surgery option for thyroid and parathyroid procedures. This method provides excellent cosmetic results and minimal adverse effects, addressing patient concerns about breast involvement.
Area of Science:
- Endocrine Surgery
- Minimally Invasive Surgery
- Surgical Oncology
Background:
- The bilateral axillo-breast approach (BABA) for endoscopic neck surgery, while effective for thyroid and parathyroid conditions, utilizes circumareolar incisions, causing patient reluctance.
- Patient apprehension, particularly among young females, regarding breast involvement necessitates alternative surgical approaches.
- The postauricular and axillary approach (PAA) was developed to circumvent breast incisions, utilizing postauricular incisions instead.
Purpose of the Study:
- To evaluate the feasibility and outcomes of the postauricular and axillary approach (PAA) for endoscopic neck surgery.
- To assess the safety, efficacy, and cosmetic results of PAA in patients undergoing thyroid and parathyroid procedures.
- To provide an alternative endoscopic technique that avoids breast incisions.
Main Methods:
- Ten patients underwent endoscopic neck surgery using the PAA between June 2006 and December 2007.
- Procedures involved subcutaneous infiltration, dissection of subplatysmal and subcutaneous spaces, and the use of four ports (two axillary, two postauricular) with CO2 insufflation.
- Thyroid lobectomies, subtotal thyroidectomies, total thyroidectomies, and parathyroidectomies were performed using ultrasonic shears, with careful identification of critical structures.
Main Results:
- A total of 9 procedures were performed: 2 thyroid lobectomies, 1 parathyroidectomy, 1 subtotal thyroidectomy, and 6 total thyroidectomies.
- The average operative time was 210.0 ± 43.7 minutes.
- No conversions to open surgery, permanent vocal cord palsy, or facial nerve palsy were observed. No hypocalcemia occurred in thyroidectomy patients. All patients reported excellent cosmetic outcomes and satisfaction.
Conclusions:
- The postauricular and axillary approach (PAA) is a feasible endoscopic technique for thyroid and parathyroid surgery.
- PAA provides good operative visualization and is associated with minimal adverse effects.
- The approach yields excellent cosmetic outcomes, enhancing patient satisfaction and addressing concerns about breast scarring.
