[Minimally invasive endoscopic thyroidectomy via an anterior chest approach for early papillary thyroid cancer]

To evaluate the feasibility and safety of endoscopic thyroidectomy via anterior chest approach for early papillary thyroid cancer (T1N0M0).

From July 2004 to December 2010, 91 patients with early papillary thyroid cancer underwent minimally invasive endoscopic thyroidectomy via anterior chest approach. The clinical and pathologic characteristics of patients, operation types, operative time, postoperative hospital stay time, and postoperative complications were analyzed retrospectively.

All 91 operations were successfully performed endoscopically. There was no case conversed to open surgery. The mean tumor size was (0.96 ± 0.71) cm. The operation types included unilateral lobectomy (41 cases), unilateral subtotal lobectomy (3 cases), ipsilateral lobectomy and contralateral subtotal lobectomy (42 cases), and bilateral total thyroidectomy (5 cases). Central compartment node dissection was carried out in 39 cases with the tumor diameter less than 1.0 cm and in 29 cases with the tumor diameter of 1.0 - 2.0 cm. The mean operating time was (99 ± 17) min, the mean bleeding volume was (18 ± 12) ml, and the mean post-operative hospital stay time was (3 ± 1) days. Temporary recurrent laryngeal nerve (RLN), paresis occurred in 2 cases and recovered within 1 to 2 months after the surgery. One patient showed permanent RLN paralysis. Two patients showed temporary hypoparathyroidism. No patient showed post-operative seroma and tracheal injury. There was no case with injury to the superior laryngeal nerve. No further complications, such as irritating cough, tetany, and emphysema developed after the operation. With the anterior chest wall approach, all patients had no surgical scar on the neck and thus they were satisfied with the cosmetic outcomes. All patients were disease free by follow-up of 7 to 85 (58.4 ± 17.2) months.

Minimally invasive endoscopic thyroid surgery through anterior chest approach is a feasible and safe method for the treatment of early papillary thyroid cancer. This technique had better cosmetic results and the long-term effect of this technique needs further evaluation.