Endoscopic thyroidectomy by a modified anterior chest approach: a single institution's 5-year experience

Endoscopic thyroidectomy embodies the features of both minimally invasive surgery and aesthetic surgery. However, none of the established approaches is minimally invasive and meanwhile maximally cosmetic. Here we applied a modified anterior chest approach to achieve excellent cosmesis with reduced physical invasion. Fifty-six patients with benign thyroid diseases accepted this procedure. A 10mm longitudinal incision was made about one-fourth of the distance from the xiphoid to the sternal notch. Bilateral transversal incisions (5mm and 10mm) were performed about one-third of the distance from the nipple to the sternoclavicular joint. The subfascial space was maintained with CO(2) insufflation. Endoscopic lobectomy or subtotal thyroidectomy was performed according to the diseases. Fifty-four of the 56 procedures were successfully performed endoscopically, including 41 unilateral lobectomies and 13 subtotal thyroidectomies. The mean operative time for uni- and bilateral procedures was 117.2 min and 184.5 min, respectively. Conversion occurred in two cases due to bleeding and malignant frozen section analysis, respectively. Postoperative complications included one temporary recurrent nerve palsy, one transient hypocalcemia, and one subcutaneous emphysema. 96.2%(50/52) of the patients were extremely satisfied or satisfied with the cosmetic effect. This procedure is more likely to be accepted by patients older than 30 years. Endoscopic thyroidectomy by the modified anterior chest approach is an effective procedure with both excellent aesthetic benefits and reduced physical injury.